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Eur J Cardiothorac Surg 2000;18:565-569
© 2000 Elsevier Science NL

Tricuspid valve replacement with the St. Jude Medical valve: 19 years of experience

Department of Surgery, Kurume University School of Medicine, Kurume, Japan

Received 12 May 2000; received in revised form 2 August 2000; accepted 5 September 2000.

Corresponding author. National Kyushu Medical Center Hospital, 1-8-1 Jigyouhama, Chuoku, Fukuoka, 810-8563 Japan, Tel.: +81-92-852-0700; fax: +81-92-846-8485
e-mail: hkawano{at}qmed.hosp.go.jp

Objective: The choice of the valve substitute in the tricuspid position remains controversial. A St. Jude Medical valve is a choice of valve substitute and its lower thrombogenicity and excellent hemodynamic performance have been reported even in the tricuspid position. However, little is known of the long-term durability of the St. Jude Medical valve in the tricuspid position. Our long-term experience of tricuspid valve replacement showed the higher thrombogenicity than we had expected, therefore, this study was done to reconsider our strategy for valve choice. Methods: This study reviewed 23 patient who underwent 25 tricuspid valve replacements with the St. Jude Medical valves from 1980 to 1997. The mean age was 40 years. Eleven patients (48%) were men. There were four in-hospital deaths (17%). The remaining 19 patients were all alive and followed from 2.2 to 19.0 years (mean 11.8 years). Results: The overall survival, including hospital mortality, was 83%, 10 and 15 years after surgery. Valve thrombosis occurred in six patients. Freedom from valve thrombosis was 78 and 70%, 10 and 15 years after surgery, respectively. The linearized rate of the valve thrombosis was 2.9%/patient-years. Six patients required reoperation. The mean interval to reoperation was 9.5 years. Freedom from reoperation was 83% and 75%, 10 and 15 years after surgery, respectively. The linearized rate of the reoperation was 2.8%/patient-years. No structural valve deterioration was found. Echocardiographic study showed that the function of the St. Jude Medical valve without valve-related complications was well maintained. Conclusions: The higher thrombogenicity of the St. Jude Medical valve in the tricuspid position altered our choice of valve substitutes from the St. Jude Medical valve to a bioprosthesis which is lack of need for anticoagulant therapy except for juvenile patients who are able to maintain potent anticoagulant therapy.

Key Words: Tricuspid valve replacement • St. Jude Medical • Tricuspid valve replacement

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