Department of Cardiovascular Disease E. Malan, Cardiac Surgery Unit, IRCCS Policlinico San Donato Hospital, Milan, Italy.
Ann Thorac Surg. 2012 Apr;93(4):1146-53. doi: 10.1016/j.athoracsur.2011.12.031. Epub 2012 Feb 18.
Tricuspid valve replacement (TVR) has historically been associated with high mortality and morbidity, and current knowledge of long-term results of TVR is limited. This study reviewed our experience from a consecutive series at 2 institutions.
Ninety patients (65 women [72%]; mean age, 53.8 ± 14.2 years; mean body surface area, 1.6 ± 0.2 m(2)) underwent TVR between January 1980 and December 2005. The etiology was secondary to left-heart valve disease in 56 patients (62%), degenerative disease in 16 (18%), Ebstein anomaly in 7 (8%), and endocarditis in 11 (12%). Seventy patients (78%) were in New York Heart Association class III or IV. Sixty patients (67%) underwent redo procedures. TVR was with a mechanical valve in 46 patients (51%) and a biologic prosthesis in 44 (49%).
The overall operative mortality was 17.7% (16 patients). During follow-up, 16 of the 74 survivors died. Kaplan-Meier survival at 5, 10, and 15 years was, respectively, 72%, 65%, and 63%. During follow-up, 16 patients (21.6%) underwent reoperation; among them, 8 with a mechanical valve underwent reoperation for tricuspid valve thrombosis and 6 with a biologic prosthesis for tricuspid valve deterioration. However, freedom from reoperation at 5 and 10 years was similar between mechanical (86% and 76%) and bioprostheses (97% and 83%). All 16 patients survived the reoperation.
The present experience suggests that the type of implanted prosthesis in the tricuspid position does not affect early and long-term outcomes or the reoperation rate. Timely referral before end-stage cardiac impairment develops could determine further outcomes improvement.
三尖瓣置换术（TVR）历史上与高死亡率和发病率相关，目前对 TVR 长期结果的了解有限。本研究回顾了我们在 2 家机构的连续系列经验。
1980 年 1 月至 2005 年 12 月期间，90 例患者（65 例女性[72%]；平均年龄 53.8±14.2 岁；平均体表面积 1.6±0.2m²）接受了 TVR。病因继发于左心瓣膜疾病 56 例（62%）、退行性疾病 16 例（18%）、Ebstein 异常 7 例（8%）和心内膜炎 11 例（12%）。70 例（78%）为纽约心脏协会 III 或 IV 级。60 例（67%）为再次手术。46 例（51%）患者接受机械瓣膜置换，44 例（49%）接受生物假体置换。
总手术死亡率为 17.7%（16 例）。随访期间，74 例存活者中有 16 例死亡。5、10 和 15 年的 Kaplan-Meier 生存率分别为 72%、65%和 63%。随访期间，16 例（21.6%）再次手术；其中 8 例机械瓣患者因三尖瓣血栓形成再次手术，6 例生物瓣患者因三尖瓣恶化再次手术。然而，机械瓣（86%和 76%）和生物假体（97%和 83%）的 5 年和 10 年无再手术生存率相似。所有 16 例患者均存活。
目前的经验表明，三尖瓣位置植入的假体类型不影响早期和长期结果或再手术率。在终末期心脏损害发生之前及时转诊可能会进一步改善结果。
