Department of Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
Ann Thorac Surg. 2012 Jul;94(1):52-7; discussion 58. doi: 10.1016/j.athoracsur.2012.03.020. Epub 2012 May 16.
Mitral valve (MV) disease is often accompanied by concomitant tricuspid valve (TV) disease. This study determined the influence of performing TV procedures in the setting of MV operations within a multiinstitutional patient population.
From 2001 to 2008, 5,495 MV operations were performed at 17 different statewide centers. Of these, 5,062 patients (age, 63.4 ± 13.0 years) underwent an MV operation and 433 (age, 64.0 ± 14.2 years) underwent combined MV and TV (MV+TV) operations. The influence of concomitant TV procedures on operative death and the composite incidence of major complications was assessed by univariate and multivariate analyses.
Patients undergoing MV+TV were more commonly women (62.7% vs 45.5%, p < 0.001), had higher rates of heart failure (73.7% vs 50.9%, p < 0.001), and more frequently underwent reoperations (17.1% vs 7.4%, p < 0.001) compared with MV patients. Other patient characteristics, including preoperative endocarditis (8.5% vs 8.2%, p = 0.78), were similar between groups. MV replacement (63.5%) was more common than repair (36.5%, p < 0.001) in MV+TV operations, and MV+TV operations incurred longer median cardiopulmonary bypass times (181 vs 149 minutes, p < 0.001). Unadjusted operative mortality (6.0% vs 10.4%, p = 0.001) and postoperative complications were higher after MV+TV compared with MV. More important, risk adjustment showed performance of concomitant TV procedures was an independent predictor of operative death (odds ratio, 1.50; p = 0.03) and major complications (odds ratio, 1.39; p = 0.004).
A concomitant TV operation is a proxy for more advanced valve disease. Compared with MV operations alone, simultaneous MV+TV operations are associated with elevated morbidity and death, even after risk adjustment. This elevated risk should be considered during preoperative patient risk stratification.
二尖瓣（MV）疾病常伴有三尖瓣（TV）疾病。本研究旨在确定在多机构患者人群中，MV 手术中同时进行 TV 手术的影响。
2001 年至 2008 年，在 17 个全州性中心进行了 5495 例 MV 手术。其中，5062 例患者（年龄 63.4±13.0 岁）接受了 MV 手术，433 例（年龄 64.0±14.2 岁）接受了 MV+TV 联合手术。通过单变量和多变量分析评估同时进行 TV 手术对手术死亡率和主要并发症综合发生率的影响。
MV+TV 组患者更常见为女性（62.7% vs. 45.5%，p<0.001），心力衰竭发生率更高（73.7% vs. 50.9%，p<0.001），再次手术率更高（17.1% vs. 7.4%，p<0.001）。与 MV 患者相比，其他患者特征，包括术前心内膜炎（8.5% vs. 8.2%，p=0.78），在两组间相似。MV+TV 手术中 MV 置换（63.5%）比修复（36.5%）更为常见（p<0.001），MV+TV 手术的中位体外循环时间更长（181 分钟 vs. 149 分钟，p<0.001）。MV+TV 组未调整的手术死亡率（6.0% vs. 10.4%，p=0.001）和术后并发症高于 MV 组。更重要的是，风险调整显示，同时进行 TV 手术是手术死亡（优势比，1.50；p=0.03）和主要并发症（优势比，1.39；p=0.004）的独立预测因素。
同时进行 TV 手术是更严重瓣膜疾病的代表。与单独 MV 手术相比，同期 MV+TV 手术与发病率和死亡率升高相关，即使进行风险调整后也是如此。在术前患者风险分层时应考虑到这种增加的风险。
