Our experience with the ATS Medical mechanical valve prosthesis in the tricuspid position

At our institution we have been performing infrequent tricuspid valve replacement for the past thirty years. Prior to 1980, we experienced unsatisfactory results with a number of mechanical and biological prostheses (Table 1). Although we had some remarkable exceptions, this fifty year old female (Fig. 1) is leading a normal but noisy life 26 years after triple valve replacement, the usual outcomes were similar to what is shown in Fig. 2. Although our frequency of tricuspid implants had been decreasing, in April, 1981, we began implanting the St. Jude Medical valve for a total of five patients. After 13 years of close observation of this small group of patients it was apparent that with an adequate anticoagulation regime, the St. Jude Medical prosthesis was a good substitute to use in cases of an irreparable tricuspid valve. We did have one patient who encountered three episodes of partial valve thrombosis, all in connection with a gross mishandling of her anticoagulation regime by her dentist; succesfully treated with thrombolytic therapy. Table 1 Valve prosthesis used in tricuspid position until 1980 Starr-Edwards 28 Fascia lata 8 Bjork-Shiley 39 Hancock 24 Duramater 1