Duke University Medical Center, Durham, North Carolina.
Duke Clinical Research Institute, Durham, North Carolina.
Ann Thorac Surg. 2013 Oct;96(4):1374-1381. doi: 10.1016/j.athoracsur.2013.05.046. Epub 2013 Aug 20.
Tricuspid valve (TV) infective endocarditis (IE) accounts for 15% of IE cases and usually is treated medically. Surgical intervention is rare, and understanding of treatment options is based on small series of patients. The purpose of this study was to describe the population and outcomes for isolated TV IE using The Society of Thoracic Surgeons Adult Cardiac Database.
Between 2002 and 2009, 910 operations for TV IE were performed. Procedures included replacement, repair, and valvectomy. Healed IE was present in 31.4% (n = 286), and active IE, in 68.5% (n = 624). Baseline patient characteristics as well as operative mortality and morbidity were analyzed, and univariate statistical differences were evaluated by Kruskal-Wallis test and stratum-adjusted Mantel-Haenszel χ(2) tests.
The median age was 40 years, with 50.6% male. Replacement of the TV was the most common procedure (n = 490; 53.8%), followed by TV repair (n = 354; 38.9%) and valvectomy (n = 66; 7.2%). Overall operative mortality was 7.3%, with no significant difference in mortality among valvectomy 12%, repair 7.6%, and replacement 6.3% (p = 0.34). Compared with the active group, healed patients experienced a trend toward lower operative mortality (4.2% versus 8.6%; p = 0.06), lower complication rates (35.6% versus 51.4%; p = 0.0004), and shorter overall length of stay (12 versus 22 days; p < 0.0001).
Isolated TV operation for IE is a rare clinical entity with a similar operative mortality to left-sided IE operations. Repair and replacement of the TV had similar perioperative mortality. Patients in the healed TV IE group demonstrated lower complication rates, length of stay, and a trend toward decreased mortality.
三尖瓣感染性心内膜炎（IE）占 IE 病例的 15%，通常采用药物治疗。手术干预很少见，对治疗方案的了解基于对少数患者的系列研究。本研究旨在通过胸外科医师学会成人心脏数据库描述孤立性三尖瓣 IE 的人群和结局。
2002 年至 2009 年间，共进行了 910 例三尖瓣 IE 手术。手术方式包括瓣膜置换、修复和瓣膜切除术。其中，31.4%（n=286）为愈合性心内膜炎，68.5%（n=624）为活动性心内膜炎。分析了患者的基线特征以及手术死亡率和发病率，并通过 Kruskal-Wallis 检验和分层调整的 Mantel-Haenszel χ(2)检验评估了单变量统计差异。
中位年龄为 40 岁，50.6%为男性。三尖瓣置换最为常见（n=490；53.8%），其次为三尖瓣修复（n=354；38.9%）和瓣膜切除术（n=66；7.2%）。总的手术死亡率为 7.3%，瓣膜切除术 12%、修复术 7.6%和置换术 6.3%之间死亡率无显著差异（p=0.34）。与活动性心内膜炎患者相比，愈合性心内膜炎患者的手术死亡率呈下降趋势（4.2%比 8.6%；p=0.06），并发症发生率（35.6%比 51.4%；p=0.0004）和总住院时间（12 天比 22 天；p<0.0001）也较低。
孤立性三尖瓣 IE 手术是一种罕见的临床实体，其手术死亡率与左侧 IE 手术相似。三尖瓣修复和置换术的围手术期死亡率相似。愈合性三尖瓣 IE 患者的并发症发生率、住院时间和死亡率呈下降趋势。
