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European Heart Journal 1980 1(1):55-61;
Copyright © 1980 by the European Society of Cardiology.
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© 1980 The European Society of Cardiology

Can a mechanical heart valve be used in the tricusid position? Experience with the Björk-Shiley tilting disc valve in 70 patients

V. O. BJÖRK, A. HENZE and Á. PÉTERFFY

Karolinska Sjukhuset, Thoracic Surgical Clinic 104 01 Stockholm 60, Sweden

Received 5 November 1979; .

Experience of the Björk-Shiley tilting disc valve as replacement for irreparably diseased tricuspid valves in 70 consecutive patients is reported. There were 11 isolated tricuspid valve replacements and 59 in combination with other valve replacements. Only 1/17 early deaths was attributable to the tricuspid prosthesis per se and 1/3 late deaths was probably an anticoagulant complication. The main problem was late thrombotic malfunction of the tricuspid prosthesis in four patients on eight occasions (3.2% year–1). Ebstein's anomaly and deficient anticoagulation were probable aetiological factors, although the complication remained unexplained in three instances. Relief by means of thrombolytic treatment(4) and re-replacement(4) involved neither disabling complications nor mortality. Normal function of the tricuspid prosthesis was observed in 49/53 patients over an average period of 4.9 years (range 0.2–9 years). There were no instances of tricuspid prosthetic endocarditis, paraprosthetic leakage or other serious complications. We consider the Björk-Shiley prosthesis a suitable replacement for most cases of irreparable tricuspid valvular disease, provided that anticoagulation can be managed effectively. The only questionable indication is Ebstein's anomaly, which constitutes a high risk of thrombotic malfunction of the tricuspid prosthesis.

Key Words: Triscuspid valve replacement (TVR) • Björk-Shiley prosthesis • thrombotic malfunction • thrombotic treatment


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