Fukunaga Naoto, Okada Yukikatsu, Konishi Yasunobu, Murashita Takashi, Kanemitsu Hideo, Koyama Tadaaki
Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
Department of Cardiovascular surgery, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, Japan.
J Thorac Cardiovasc Surg. 2014 Nov;148(5):1983-8. doi: 10.1016/j.jtcvs.2013.08.089. Epub 2014 Jan 12.
The impact on survival of tricuspid regurgitation (TR) after redo valvular surgery in patients with previous mitral valve replacement (MVR) is unclear.
We retrospectively analyzed 118 consecutive patients undergoing redo valvular surgery after MVR over a 20-year period. We determined the impact of TR after redo valvular surgery on survival and clinical factors that were associated with TR of 2+ or higher. The mean follow-up period was 7.1±6.5 years.
Overall hospital mortality was 8.5% (10 of 118). Logistic regression analysis revealed that cardiopulmonary bypass duration (odds ratio, 1.025; P=.0270) was an independent risk factor for hospital death. There were 25 late deaths. Survival after 5, 10, and 15 years was 77.5%±4.2%, 68.5%±5.1%, and 58.8%±6.3%, respectively. Multivariate Cox regression analysis showed that TR less than 2+ at discharge was a predictor of late survival (hazard ratio, 0.043; P<.0382), whereas age, female sex, left ventricular end-diastolic dimension, and cardiopulmonary bypass duration were predictors of late death. Survival for patients with TR less than 2+ versus 2+ or higher after redo surgery were 91.4%±3.4% versus 59.5%±11.9% at 5 years and 81.1%±5.3% versus 52.1%±12.5% at 10 years, respectively (log-rank P=.0285). Logistic regression analysis indicated that preoperative TR (odds ratio, 3.718; P=.0044) and chronic obstructive pulmonary disease (odds ratio, 28.576; P=.0154) were independent risk factors for TR of 2+ or higher after redo surgery.
Survival in patients with TR of 2+ or higher after redo valvular surgery was poor. The results of this study suggest that it is important to maintain a postoperative TR less than 2+ to improve long-term survival.
既往接受二尖瓣置换术（MVR）的患者再次行瓣膜手术时三尖瓣反流（TR）对生存的影响尚不清楚。
我们回顾性分析了20年间连续118例接受MVR后再次行瓣膜手术的患者。我们确定了再次瓣膜手术后TR对生存的影响以及与2级或更高TR相关的临床因素。平均随访期为7.1±6.5年。
总体医院死亡率为8.5%（118例中的10例）。逻辑回归分析显示，体外循环时间（比值比，1.025；P = 0.0270）是医院死亡的独立危险因素。有25例晚期死亡。5年、10年和15年的生存率分别为77.5%±4.2%、68.5%±5.1%和58.8%±6.3%。多变量Cox回归分析表明，出院时TR小于2级是晚期生存的预测因素（风险比，0.043；P < 0.0382），而年龄、女性、左心室舒张末期内径和体外循环时间是晚期死亡的预测因素。再次手术后TR小于2级与2级或更高的患者在5年时的生存率分别为91.4%±3.4%和59.5%±11.9%，在10年时分别为81.1%±5.3%和52.1%±12.5%（对数秩检验P = 0.0285）。逻辑回归分析表明，术前TR（比值比，3.718；P = 0.0044）和慢性阻塞性肺疾病（比值比，28.576；P = 0.0154）是再次手术后TR达到2级或更高的独立危险因素。
再次瓣膜手术后TR达到2级或更高的患者生存率较差。本研究结果表明，将术后TR维持在小于2级对改善长期生存很重要。
