Mechanical valves linked to superior long-term survival after tricuspid valve replacement
Tricuspid valve replacement (TVR) with a mechanical valve is associated with improved long-term survival and fewer reinterventions compared to using a tissue/bioprosthetic valve, according to a new meta-analysis published in The American Journal of Cardiology.[1]
“When TVR is unavoidable, the choice between mechanical and tissue valves for the tricuspid valve position remains controversial,” wrote first author Michel Pompeu Sá, MD, MSc, MHBA, PhD, a surgeon with the UPMC Heart and Vascular Institute, and colleagues.
Each valve type has its own benefits, the group noted. Mechanical valves tend to last longer, for instance, while tissue valves limit the need for anticoagulation therapy. On the other hand, each valve type also has certain drawbacks; mechanical valves carry a heightened bleeding risk, and tissue valves make structural valve deterioration a concern.
To learn more about this topic, the researchers tracked data from more than 7,000 patients who originally participated in one of 21 different studies. While 65.2% of patients received a tissue valve, the remaining 34.8% received a mechanical valve.
Overall, mechanical valves were linked to a lower risk of death over time than tissue valves. The restricted mean survival time was 12.4 years for patients with a mechanical valve, and 10.2 years for patient with a tissue valve.
One key takeaway from the group’s analysis was that patients presenting with atrial fibrillation (AFib) who received a mechanical valve had even better long-term survival odds.
“This is highly likely related to the fact that 100% of patients with a mechanical prosthesis and AFib must receive oral anticoagulation with a vitamin K antagonist to avoid thromboembolic events regardless of any other factors, which leads these patients to benefit from the protective effect of anticoagulation against AFib-related events including AFib-related mortality,” the group explained. “For patients with AFib who receive a tissue valve, the decision to use oral anticoagulation to prevent thromboembolic events is not well defined and should be made in a shared decision-making process, which leads to a much lower use of anticoagulation in patients with AFib who receive tissue valves.”
The meta-analysis also included data focused on tricuspid valve reinterventions after TVR. While reoperation was just as likely for mechanical and tissue valves in the first seven years following surgery, the risk was significantly lower for patients who received a mechanical valve after seven years.
“Although tissue valves in the tricuspid position are expected to have slower deterioration than those in the left side of the heart, there is evidence showing that the durability of a tissue valve in the right side of the heart ranged between seven and nine years, which is lower than that for the aortic or mitral positions,” the authors wrote.
When mechanical valves are a clinically reasonable choice, the group concluded, they appear to be linked to multiple long-term benefits that care teams should consider.
Click here to read the full meta-analysis.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.