What Is the 20-Year Durability of a Surgical Tricuspid Bioprosthesis?

Bioprosthetic tricuspid valve replacement is increasingly used to avoid the thromboembolic and bleeding burden associated with mechanical prostheses. However, long-term durability in the tricuspid position remains less well defined than in the aortic or mitral position, mainly because available studies are heterogeneous, often retrospective, and inconsistently define echocardiographic surveillance and structural valve deterioration. In contemporary literature, freedom from structural valve deterioration after bioprosthetic tricuspid valve replacement is generally high during the first decade. In the systematic review by Zancanaro et al., which included 19 studies and 2541 patients, freedom from structural valve deterioration ranged from 80% to 100% in studies reporting outcomes up to 5-10 years, whereas in studies with 15-20 years of follow-up, it ranged from 47% to 90%.1 Accordingly, the estimated proportion of patients developing structural valve deterioration by 20 years may vary widely, from approximately 10% to 53%, depending on prosthesis type, patient age, competing mortality, follow-up completeness, and the definition used for structural valve deterioration.1,2