Guenther Thomas, Noebauer Christian, Mazzitelli Domenico, Busch Raymonde, Tassani-Prell Peter, Lange Ruediger
Department of Cardiovascular Surgery, German Heart Center, Clinic at the Technical University-Munich, Lazarettstrasse 36, Munich, Germany.
Eur J Cardiothorac Surg. 2008 Aug;34(2):402-9; discussion 409. doi: 10.1016/j.ejcts.2008.05.006. Epub 2008 Jun 25.
Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid procedures are exceptionally rare. Prosthetic valve replacement is also seldom required. Generally, these patients face a high risk of operative mortality and long-term outcome is poor. In this study we reviewed our experience with TV surgery focusing on risk factors for operative mortality, long-term outcome and incidence of valve related complications.
Retrospective analysis of 416 consecutive patients >18 years with acquired TV disease operated on between 1974 and 2003. The follow-up is 97% complete (mean 5.9+/-6.3 years). Three hundred and sixty-six patients (88%) underwent TV surgery with concomitant mitral (n=340) or aortic (n=100) valve surgery. The tricuspid valve was repaired in 310 patients (74.5%) and replaced in 106 (25.5%). A biological prosthesis was used in 68 patients (64%). Mean age at repair and replacement was 61+/-12.5 and 50+/-11.3 years, respectively (p<0.001).
Overall 30-day mortality was 18.8% (78/416) and decreased from 33.3% (1974-1979) to 11.1% (2000-2003) (p< or =0.0001). Thirty-day mortality after TV repair and replacement was 13.9% (43/310) and 33% (35/106), respectively (p< or =0.001). Cox regression analysis revealed TV replacement as an independent predictor of 30-day mortality. Ten-year actuarial survival after TV repair and replacement was 47+/-3.5% and 37+/-4.8%, respectively (p=0.002). Forty-five patients (10.8%) required a TV re-operation after 7.7+/-5.1 years. Freedom from TV re-operation 10 years after TV repair and replacement was 83+/-3.6% and 79+/-6.1%, respectively (p=0.092).
Patients who require tricuspid valve surgery constitute a high-risk group. Tricuspid valve repair is associated with better perioperative and long-term outcome than valve replacement. However, patients undergoing replacement showed a significant higher incidence of risk factors for operative mortality. The incidence of re-operation is low with no significant difference when the tricuspid valve has been repaired or replaced. When valve replacement is necessary we recommend the use of a biological prosthesis considering the poor long-term survival.
三尖瓣（TV）手术通常是在矫正其他心脏病变的同时进行的重建手术。孤立的三尖瓣手术极为罕见。人工瓣膜置换也很少需要。一般来说，这些患者手术死亡率高，长期预后差。在本研究中，我们回顾了我们在TV手术方面的经验，重点关注手术死亡率、长期预后及瓣膜相关并发症的危险因素。
对1974年至2003年间接受后天性TV疾病手术的416例年龄大于18岁的连续患者进行回顾性分析。随访完成率为97%（平均5.9±6.3年）。366例患者（88%）在进行TV手术的同时接受了二尖瓣（n = 340）或主动脉瓣（n = 100）手术。310例患者（74.5%）的三尖瓣得到修复，106例（25.5%）进行了置换。68例患者（64%）使用了生物假体。修复和置换时的平均年龄分别为61±12.5岁和50±11.3岁（p < 0.001）。
总体30天死亡率为18.8%（78/416），并从1974 - 1979年的33.3%降至2000 - 2003年的11.1%（p≤0.0001）。TV修复和置换后的30天死亡率分别为13.9%（43/310）和33%（35/106）（p≤0.001）。Cox回归分析显示TV置换是30天死亡率的独立预测因素。TV修复和置换后的10年精算生存率分别为47±3.5%和37±4.8%（p = 0.002）。45例患者（10.8%）在7.7±5.1年后需要再次进行TV手术。TV修复和置换后10年无需再次进行TV手术的概率分别为83±3.6%和79±6.1%（p = 0.092）。
需要进行三尖瓣手术的患者构成高危人群。三尖瓣修复与瓣膜置换相比，围手术期和长期预后更好。然而，接受置换的患者手术死亡率的危险因素发生率显著更高。再次手术的发生率较低，三尖瓣修复或置换后无显著差异。当需要进行瓣膜置换时，考虑到长期生存率较低，我们建议使用生物假体。
