Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Ann Thorac Surg. 2013 Jun;95(6):2007-13. doi: 10.1016/j.athoracsur.2013.03.007. Epub 2013 Apr 23.
The management of late tricuspid regurgitation after left-sided valve operations in rheumatic patients remains controversial. The aim of this study was to analyze clinical and echocardiographic outcomes of tricuspid valve procedures after left-sided valve operations in rheumatic patients.
This study enrolled 106 rheumatic patients with a history of left-sided valve operations who were undergoing tricuspid valve procedures (53 replacements, 53 repairs). Follow-up was 97% complete, with a mean follow-up of 62 ± 42 months. Clinical and echocardiographic data were analyzed.
The early mortality rate was 1.9% (2 of 106 patients). There was no significant difference in cumulative survival at 10 years between patients who underwent tricuspid valve replacement (63.1% ± 13.2%) or repair (80.7% ± 0.8%, p = 0.317). Multivariable Cox regression analysis revealed that old age (hazard ratio [HR], 6.5; p = 0.007), anemia (HR, 10.9; p = 0.004), and left ventricular ejection fraction of less than 0.4 (HR, 10.3; p = 0.001) were predictors of major adverse cardiac events. Among patients who underwent tricuspid valve repair, multivariate analysis revealed that the aortic transprosthetic mean pressure gradient at late follow-up was an independent predictor of late tricuspid regurgitation.
Tricuspid valve procedures after left-sided valve operations in rheumatic patients can be performed at low risk with good clinical outcomes. For improved clinical outcomes, early surgical intervention should be considered before the development of anemia and left ventricular dysfunction. A lower aortic transprosthetic mean pressure gradient may help prevent late progression of tricuspid regurgitation in a clinical setting.
风湿性心脏病患者行左侧瓣膜手术后晚期三尖瓣反流的处理仍存在争议。本研究旨在分析风湿性心脏病患者行左侧瓣膜手术后行三尖瓣手术的临床和超声心动图结果。
本研究纳入 106 例行左侧瓣膜手术的风湿性心脏病患者,这些患者均接受了三尖瓣手术(53 例瓣膜置换术,53 例瓣膜修复术)。随访率为 97%,平均随访时间为 62±42 个月。分析临床和超声心动图数据。
早期死亡率为 1.9%(2/106 例患者)。行三尖瓣置换术(63.1%±13.2%)或修复术(80.7%±0.8%,p=0.317)的患者 10 年累积生存率无显著差异。多变量 Cox 回归分析显示,高龄(风险比[HR],6.5;p=0.007)、贫血(HR,10.9;p=0.004)和左心室射血分数小于 0.4(HR,10.3;p=0.001)是主要不良心脏事件的预测因素。在接受三尖瓣修复术的患者中,多变量分析显示晚期随访时主动脉瓣跨瓣平均压力梯度是晚期三尖瓣反流的独立预测因素。
风湿性心脏病患者行左侧瓣膜手术后行三尖瓣手术的风险较低,临床结局良好。为了改善临床结局,应在贫血和左心室功能障碍发生之前考虑早期手术干预。在临床实践中,较低的主动脉瓣跨瓣平均压力梯度可能有助于预防晚期三尖瓣反流的进展。