Long-Term Outcomes After Bioprosthetic Tricuspid Valve Replacement: A Multicenter Study

Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses. This multicenter retrospective study included patients from 10 high-volume centers in seven different countries who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed, and long-term outcomes were investigated. Of the 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53 percent), while 317 (47 percent) underwent concomitant procedures. Between these two groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multiorgan failure, longer ICU and hospital stays, and higher 30-day mortality compared to patients who underwent isolated procedures. The overall 30-day mortality occurred in 70 patients (10.4 percent) (46 [14.6 percent] in the combined group vs 24 [6.74 percent] in the isolated group, p = 0.001). During follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at five, 10-, and 15-years being 27.2 percent, 46.2 percent, and 60.6 percent, respectively. In contrast, the risk of reintervention started to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1 percent, 10.8 percent, and 23.3 percent, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis, and major thromboembolic events at 15 years were 56.5 percent,77.3 percent, 84.0 percent, and 86.4 percent, respectively. The authors conclude that tricuspid valve replacement with bioprostheses is an effective treatment, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.