Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, College of Medicine, University of Hanyang, Guri, Korea.
J Korean Med Sci. 2009 Oct;24(5):818-23. doi: 10.3346/jkms.2009.24.5.818. Epub 2009 Sep 24.
Triple valve surgery is usually complex and carries a reported operative mortality of 13% and 10-yr survival of 61%. We examined surgical results based on our hospital's experience. A total of 160 consecutive patients underwent triple valve surgery from 1990 to 2006. The most common aortic and mitral valve disease was rheumatic disease (82%). The most common tricuspid valve disease was functional regurgitation (80%). Seventy-four percent of the patients were in New York Heart Association (NYHA) class III and IV. Univariate and multivariable analyses were performed to identify predictors of early and late survival. Operative mortality was 6.9% (n=11). Univariate factors associated with mortality included old age, preoperative renal failure, postoperative renal failure, pulmonary complications, and stroke. Of them, postoperative renal failure and stroke were associated with mortality on multivariable analysis. Otherwise, neither tricuspid valve replacement nor reoperation were statistically associated with late mortality. Survival at 5 and 10 yr was 87% and 84%, respectively. Ninety-two percent of the patients were in NYHA class I and II at their most recent follow-up. Ten-year freedom from prosthetic valve endocarditis was 97%; from anticoagulation-related hemorrhage, 82%; from thromboembolism, 89%; and from reoperation, 84%. Postoperative renal failure and stroke were significantly related with operative mortality. Triple valve surgery, regardless of reoperation and tricuspid valve replacement, results in acceptable long-term survival.
三尖瓣手术通常较为复杂，据报道手术死亡率为 13%，10 年生存率为 61%。我们根据我院的经验检查了手术结果。1990 年至 2006 年，共有 160 例连续患者接受了三尖瓣手术。最常见的主动脉瓣和二尖瓣疾病是风湿性疾病（82%）。最常见的三尖瓣疾病是功能性反流（80%）。74%的患者为纽约心脏协会（NYHA）III 级和 IV 级。进行了单变量和多变量分析，以确定早期和晚期生存的预测因素。手术死亡率为 6.9%（n=11）。与死亡率相关的单变量因素包括年龄较大、术前肾功能衰竭、术后肾功能衰竭、肺部并发症和中风。其中，术后肾功能衰竭和中风在多变量分析中与死亡率相关。否则，三尖瓣置换术或再次手术与晚期死亡率均无统计学关联。5 年和 10 年的生存率分别为 87%和 84%。92%的患者在最近一次随访时处于 NYHA 心功能 I 级和 II 级。10 年无假体瓣心内膜炎的发生率为 97%；抗凝相关出血为 82%；血栓栓塞为 89%；再次手术为 84%。术后肾功能衰竭和中风与手术死亡率显著相关。三尖瓣手术，无论是否再次手术和三尖瓣置换术，都可获得可接受的长期生存率。
