Long-term outcomes of bioprosthetic tricuspid valves: a systematic review of studies published over the last 20 years

Although the use of bioprostheses for tricuspid valve replacement (bTVR) has always been controversial in terms of results, their long-term durability is not well described. This systematic review aimed to identify, assess the quality, and review the outcomes in studies reporting on long-term outcomes after bTVR published over the last 20 years. Medline, Embase, and Cochrane CENTRAL were searched for studies reporting on at least five years of follow-up after bTVR. Cohort characteristics, definitions of structural valve deterioration (SVD), whose definition followed the criteria, and outcomes were summarized. The risk of bias in included studies was assessed using the Cochrane QUIPS tool. Ninteen studies, including 2541 patients were identified. The commonest implanted bioprosthesis was porcine-type with 1950 patients receiving this valve, followed by bovine pericardial (BP) type with 591 cases. Freedom from SVD in studies reporting outcomes up to 5-10 years ranged from 80% to 100% and in studies reporting to 15-20 years from 47% to 90%. Freedom from re-operation in studies reporting up to 5-10 years ranged from 94.7% to 100% and in studies reporting up to 15-20 years ranged from 49% to 95%. Reports of post-operative echocardiography were lacking, despite the heavy reliance on echocardiography for SVD diagnosis. There is considerable variability in reporting bTVR-related long-term outcomes. As such, it is difficult to generate an unbiased, generalizable understanding of long-term outcomes after bTVR across the spectrum of tricuspid disease phenotypes. Future clinical research will require more attention and detailed data report to fil such a gap.