[Early and late term results of triple valve replacements. Use of a tricuspid bioprosthesis].

Triple valve replacement (TVR) is associated with an increased operative and long-term mortality rate. The aim of this study was to reduce operative mortality by effective myocardial protection (coronary perfusion with moderate hypothermia) and to improve long-term results by the optimal choice of valve prosthesis and, in particular, by the systematic use of xenografts for tricuspid valve replacement. Twenty TVR were performed between 1970 and 1977. Björk-Shiley prostheses were used for aortic valve replacement, Starr Edwards 6120 valves for mitral valve replacement and xenografts (7 aortic valve and 13 Hancock xenografts) for tricuspid valve replacement. This series represented 3.2% of the total number of valve replacements carried out during this period. The average postoperative follow-up was 52.6 +/- 15.2 months. Only one patient died in the first postoperative month (early mortality 5%). There were 2 late deaths, one from heart failure and one from accidental causes; the actuarial 5 year survival rate was 87.9%. Seventeen long-term survivors were studied; 6 were functionally improved. Significant (p less than 0.02) but moderate regression of cardiomegaly was observed. Abnormal auscultatory findings in the tricuspid area were found in 64.7% of survivors, and signs of mild right ventricular failure were elicited in 30.4%. There were no early or late complications due to the tricuspid valve xenograft. Thirteen patients had cardiac catheterisation over one year after operation: right atrial and mean pulmonary artery pressures were significantly reduced (p less than 0.001 and p less than 0.01 respectively); there was a moderate increase in cardiac index( p less than 0.001). Late clinical complications were rare, only one regressive cerebral embolism was observed. Triple valve replacement, when necessary, carried a limited early postoperative risk, and satisfactory functional and haemodynamic results may be obtained in the long term.