Clinical evaluation of the Björk-Shiley tilting disc valve in the tricuspid position. Early and late results in 10 isolated and 51 combined cases.

Tricuspid valve replacement with the Björk-Shiley tilting disc valve was performed in 61 consecutive patients with either organic disease causing valve malfunction or functional regurgitation of severe degree. The early mortality rate was 21% (13/61) for the entire series. It was 10% (1/10) for tricuspid valve replacement alone, 27% (9/33) for mitral and tricuspid valve replacement, and 18% (3/17) for triple valve replacement. Age over 60 years, functional capacity group IV (N.Y.H.A.) and heart volume over 900 ml/m2 BSA were factors associated with a high operative mortality. There were 3 late deaths, 42, 42 and 45 months, respectively, after surgery, due to arrhythmia (2) and anticoagulant complications (1). The Björk-Shiley prosthesis has functioned well and with satisfactory clinical improvement in the majority of the 48 long-term survivors, for an average period of 2.8 years. There were, however, 3 cases of prosthetic valve failure due to thrombotic obstruction following isolated tricuspid replacement because of Ebstein's anomaly (2) and traumatic tricuspid valvular incompetence (1). Reoperation with insertion of a new Björk-Shiley prosthesis involved no mortality. One patient, however, had a recurrent prosthetic thrombosis which was successfully treated with streptokinase. Only one patient in the series, who underwent triple valve replacement, suffered from systemic embolism, an incidence of 0.7 per 100 patient years. There were no episodes of pulmonary embolism or infective endocarditis.