Comparison of mechanical and bioprosthesis valves in tricuspite valve replacement

Abstract: This thesis study examines the superiority of mechanical prostheses over bioprosthetic valves in tricuspid valve replacement. Additionally, it aims to determine the best option for tricuspid valve replacement by analyzing the early and long-term outcomes of mechanical and bioprosthetic valves. Methods: A retrospective analysis was conducted on patients who underwent tricuspid valve replacement at two different centers between 2014 and 2023. Demographic, clinical, and operative data were collected and analyzed. Evaluation was performed on primary outcomes such as early and late mortality rates, reoperation rates, and postoperative complications. Results: A total of 83 patients were included in the study, with 48 receiving bioprosthetic valves and 35 receiving mechanical valves. The patients were 67% female. The mean age was 55.7±11.65 years in the bioprosthetic valve group and 50.7±12.08 years in the mechanical valve group, showing a statistically significant difference (p < 0.05). There was no significant difference in early and late mortality rates between the groups. Risk factors identified to increase early and late mortality included right ventricular function, combined surgeries, and reoperation cases. Preoperative data showed a higher prevalence of comorbidities in the bioprosthetic valve group. The redo surgery rate in the study population was 67%, with higher early mortality observed in redo cases compared to primary surgery cases. Among the cases, 39% were combined cases, and 61% were isolated tricuspid valve replacements. The choice of valve type varied over the years, with an observed increase in the use of mechanical valves in patients currently receiving anticoagulation therapy, following guideline recommendations. Among the 33 patients who received bioprosthetic valves in our study, valve degeneration was detected in 3 patients, and 2 patients underwent re-Tricuspid Valve Replacement (TVR). In the mechanical valve group, 1 patient received medical treatment due to stuck valve, and 2 patients underwent re-TVR out of 27 patients. Conclusion: This retrospective analysis compares the outcomes of mechanical and bioprosthetic valves in tricuspid valve replacement, shedding light on factors influencing valve selection. The findings demonstrated that both valve types have similar short and long-term outcomes. Based on the results, mechanical TVR is not inferior to bioprosthetic TVR. The selection of the prosthetic valve in the tricuspid position should be made in consideration of the patient's risk factors and involving the patient in the decision-making process. Following careful evaluation, early surgical intervention without impairing right ventricular functions could be the key to improving long-term outcomes. Further studies with larger sample sizes and prospective designs are needed to confirm the current findings and guide clinical decisions in tricuspid valve replacement.