Objective To assess the performance of three Biological Tricuspid Valve replacements (St Jude Epic, Perimount and Hancock) in congenital heart disease patients. Currently, there is little comparative data on the long term performance of these biological tricuspid valve replacements.
Methods We audited the performance of the valve replacements in all the patients with Congenital Heart Disease (n=50) who had Biological Tricuspid Valve replacements in the Queen Elizabeth Hospital, Birmingham, from 2000 to present. For each patient, we collected echocardiogram data at baseline (the first data available after their surgery) and at their most recent review. Valve performance was assessed according to criteria set out by the American Society of Echocardiology (ASE) in terms of valve stenosis and regurgitation. We also looked at patient-reported symptoms before surgery and at most recent review.
Valve was Stenosed if one or more of the following was met: Mean gradient 6 mmHg; Peak velocity >1.7 m/s; Pressure half time >230 ms.
Valve was Regurgitant if the following was met: Tricuspid regurgitation > Mild regurgitation on report.
Patient Declined symptomatically if one or more of the following was met: NYHA class unchanged or worsened; new arrhythmia post-op; decrease in measured peak V02. All mortalities that occured during follow-up were recorded. These patients were not included in the analysis.
Results Only two Hancock valves had been used since 2000, which was too few to be able to draw any reliable conclusions. Table 1 presents background data for the other two valves; Table 2 presents the comparison of their performance. Proportionately fewer Perimount valves became stenosed or regurgitant than the St Jude Epic valves. St Jude Epic valves were associated with improved peak VO2, however average NYHA class reduction (improvement) was greater in those with the Perimount. This may reflect the case mix in this small number of patients.
Discussion and conclusion Tricuspid valve replacement is rarely performed and the choice of which valve to use is not assisted by any published data. This audit suggests that the Perimount valve in the tricuspid position has a marginally better echo profile than the St Jude Epic valve over a three year follow up. The cohort is too small to make recommendations on which valve to use, but has highlighted a relatively high early attrition rate in terms of bioprosthetic valve function in the tricuspid position.
Therefore we propose that valve surveillance is carried out annually for these valves and that valve dysfunction merits further investigation. We propose to perform CT evaluation of dysfunctional bioprosthetic valves for evidence of thrombus and this will be prospectively audited.
- Biological Tricuspid Valve Replacement
- Valve performance
- Congenital Heart Disease
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