[Tricuspid valve replacement with aortic valve allograft. Clinical and haemodynamic results more than five years after (author's transl)].

Between 1970 and 1974, twenty-three patients with advanced multivalve lesions underwent tricuspid valve replacement with a human aortic valve allograft (26-28 mm in diameter) mounted on a Shumway ring. The mean follow-up was 76.7 months. Early post-operative mortality was 4.4% and late mortality 17.4%. The actuarial survival rate was 86.6% at 5 years and 74.2% at 8 years. In 1979, 17 out of 18 survivors (one was lost sight of) were reinvestigated by cardiologists. Late functional improvement z found in 82.2% of the cases; two patients failed to improve owing to recurrent mitral stenosis. On clinical examination 12 out of 15 subjects showed no sign of right ventricular failure. In 54% the cases phonocardiography revealed abnormal tricuspid sounds indicating variable and moderate deterioration of the allograft. Haemodynamic studies showed a significant decrease in mean right atrial pressure (p less than 0.001) and mean pulmonary artery pressure (p less than 0.001), and an increase in cardiac index (p less than 0.01). The diastolic gradient through the graft was always inferior to 3 mmHg (mean 1.2 mmHg), with little change on exercise. This was significantly less than the 3.9 mmHg gradient observed with tricuspid valve replacement using Hancok valve. These were the only tricuspid valve replacements performed in our unit in 1970-74. The satisfactory long-term results obtained contrast with the frequent deterioration observed in aortic valve replacements carried out during the same period by the same team, using the same technique