Partial replacement of the tricuspid valve using cryopreserved tricuspid homograft: 20-year outcomes

Objectives: There is limited consensus on the optimal strategy for surgical treatment of severe tricuspid valve pathology. At our institution, we have implemented a unique technique of using a tricuspid homograft with its supporting apparatus for partial replacement of the native tricuspid valve. We now present the long-term outcomes of these patients.

Methods: We analysed a cohort of patients who underwent partial tricuspid valve replacement using tricuspid homograft. Yearly clinical and echocardiographic follow-up was performed. Fine-Gray methods were used to estimate freedom from death and reoperation and reverse Kaplan-Meier methods were used to calculate follow-up.

Results: Fourteen patients were included (age range 15 days to 73 years). Indications included congenital anomalies (n = 9, 64%) and infective endocarditis (n = 5, 36%). The median follow-up was 17 years (95% confidence interval (CI) 10-21 years). Two patients (14%) died due to causes unrelated to the primary tricuspid valve surgery, and three (21%) underwent redo tricuspid valve operations. In the remaining cohort, seven (50%) were asymptomatic and two (14%) reported class II dyspnoea, while none had severe tricuspid regurgitation on echocardiogram. Estimated freedom from death was 93% at 10 years and 83% at 15 and 20 years, while estimated freedom from reoperation was 77% at 10, 15 and 20 years.

Conclusions: Partial replacement of the tricuspid valve using tricuspid homograft tissue effectively restores the anatomical conformity of the native tricuspid valve and has durable long-term survival and freedom from severe tricuspid regurgitation in patients with congenital anomalies and infective endocarditis.