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Durability of bioprostheses for the tricuspid valve in patients with congenital heart disease

医学 反流(循环) 心脏病学 三尖瓣 内科学 外科 假肢 舒张期 存活率 三尖瓣关闭不全 死亡率 血压
作者
Melchior Burri,Manfred Vogt,Jürgen Hörer,Julie Cleuziou,Jelena Kašnar-Šamprec,Andreas Kühn,Rüdiger Lange,Christian Schreiber
出处
期刊:European Journal of Cardio-Thoracic Surgery [Oxford University Press]
卷期号:50 (5): 988-993 被引量:26
标识
DOI:10.1093/ejcts/ezw094
摘要

Only little data exist on the durability of bioprostheses in the tricuspid position in patients with congenital heart disease (CHD). The aim of the study was to determine the reoperation rate and the valve function after primary implantation.Between 1990 and 2013, 51 patients with CHD underwent tricuspid valve (TV) replacement with a bioprosthesis. The median age at operation was 32 years (range: 8-69). The underlying morphology was Ebstein's anomaly in 62% of the patients. Implanted valves included 38 pericardial and 13 porcine valves. All available echocardiographic examinations (n = 714) and clinical data were retrospectively reviewed. Dysfunction was defined as an at least moderate regurgitation or a mean diastolic gradient ≥9 mmHg. Freedom from death, reoperation and prosthetic valve dysfunction was estimated using the Kaplan-Meier method.The 30-day mortality rate was 9%. The estimated survival rate was 86% at one and 80% at ten years. The freedom from reoperation at 1, 5 and 10 years was 100, 86 and 81%, and that from prosthesis dysfunction detected by echocardiography at 1, 5 and 10 years was 89, 66 and 58%, respectively. The main reason for dysfunction was insufficiency (89%). Valve implantation at an age below 16 years was associated with earlier reoperation and dysfunction (the 5-year freedom rate from reoperation/dysfunction was 70%/30% compared with 89%/78% in the rest of the patients, P = 0.016/0.0009).Serial echocardiography shows a high rate of dysfunction of TV bioprosthesis in patients with CHD, which already occurred a few years after implantation. In patients below 16 years of age, most prostheses are dysfunctional within 5 years.
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