Which type of valve should we use in tricuspid position? Long-term comparison between mechanical and biological valves.

BACKGROUND: Nowadays, tricuspid valve replacement (TVR) is much less common than aortic or mitral valve replacement, since repair is almost always preferable. Prosthetic tricuspid valves are associated with high mortality and morbidity, mostly due to thrombotic or hemorrhagic events. Nevertheless, there is lack of evidence of which is the optimal type of valve (biological versus mechanical) in tricuspid position. METHODS: We analyzed all the patients who underwent TVR in our Institution, from 2005 to 2015. Patient baseline characteristics were recorded (such as functional class, previous cardiac surgery, right ventricular dysfunction or pulmonary hypertension), and a clinical long-term follow-up was conducted. We compared the outcomes between mechanical and biological prostheses: in-hospital mortality, long-term mortality, need for reintervention and adverse events (such as stroke or valve thrombosis). RESULTS: During the study period 120 tricuspid prosthetic valves were implanted in 111 patients. 81 of them (67.5%) were bioprostheses, and 39 (32.5%) mechanical valves. 73 patients (60.8%) had undergone a previous cardiac surgery (28.4% had previous tricuspid surgery). Most of the patients (87.1%) were in high functional class (grade III-IV of the NYHA classification), and 85% had moderate to severe pulmonary hypertension. Mean logistic EuroSCORE I was 14.80%. Only 37 cases were isolated TVR (30.6%), as most of the cases were TVR concomitant to mitral valve replacement. In-hospital mortality was 21.7%, and during the follow-up (mean follow-up of 7 years) reached 37.5%. Three mechanical tricuspid valves (7.7%) had to be replaced due to thrombosis, while 7 biological valves (8.6%) had to be replaced due to valve deterioration. The incidence of stroke was 7.5%. CONCLUSIONS: Tricuspid valve replacement is an infrequent procedure with a high incidence of perioperative morbidity and mortality. Biological or mechanical valves have similar mortality, and a reasonably low incidence of need for reintervention due to thrombosis or valve deterioration.

Rotura iatrogénica de electrodos de marcapasos permanente en la realización de esternotomía media: presentación de un caso / Iatrogenic rupture of permanent pacemaker electrodes while performing a median sternotomy: a case report

RESUMEN La esternotomía media continúa siendo el gold-standart de abordaje quirúrgico en cirugía cardiaca. Aún realizada correctamente, la apertura media del esternón presenta complicaciones en el 1-5% de los casos que varían en su gravedad desde la infección de la herida quirúrgica a la lesión de estructuras intratorácicas. En el presente estudio se describe un caso de rotura de electrodos de marcapasos tras esternotomía media por retracción y fibrosis del tronco venoso braquiocefálico. Debido a la ausencia de artículos semejantes en la literatura y al extendido empleo de la esternotomía en pacientes portadores de marcapasos permanente, se pretende disminuir las lesiones asociadas mediante la publicación de un infrecuente caso de lesión iatrogénica durante la apertura esternal, con escasos precedentes en la literatura publicada hasta la fecha. MÉD.UIS. 2016;29(3):95-9.

ABSTRACT Median sternotomy is still the gold-standard surgical approach in cardiac surgery. Even correctly performed, the sternum median opening presents complications in an incidence of 1-5% of cases comprising in severity from infection of the surgical wound to the injury of intrathoracic structures. We describe a case in which the pacemaker leads were broken after median sternotomy because of the brachiocephalic vein fibrosis. Due to the absence of similar items in the literature and the widespread use of sternotomy in patients with permanent pacemakers, we intended to reduce associated injuries by posting a rare case of iatrogenic injury during sternal opening with few precedents in the literature. MÉD.UIS. 2016;29(3):95-9.