Hwang Ho Young, Kim Kyung-Hwan, Kim Ki-Bong, Ahn Hyuk
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
Eur J Cardiothorac Surg. 2014 Aug;46(2):e21-7. doi: 10.1093/ejcts/ezu224. Epub 2014 Jun 10.
Previous studies have compared the outcomes of mitral annuloplasty with those of mitral valve replacement in patients with functional mitral regurgitation. However, data comparing the results of tricuspid annuloplasty (TAP) with those of tricuspid valve replacement (TVR) in patients with functional tricuspid regurgitation (FTR) have been scarce. We evaluated whether TAP was an optimal option for severe FTR.
From 1996 to 2012, 175 patients (57 ± 11 years old) underwent surgical correction for severe FTR. A total of 108 patients underwent TAP (the TAP group), and 67 underwent TVR (the TVR group). Inverse probability of treatment weighting (IPTW) analysis and propensity score matching with 37 patients in each group were performed to adjust for the baseline differences between the two groups.
Early mortality occurred in 13 patients without any inter-group differences. There were 35 late mortalities, including 24 cardiac deaths. The 5- and 10-year freedom rates from cardiac death were 93.0 and 88.5%, respectively, in the TAP group, and 84.7 and 69.8%, respectively, in the TVR group. The IPTW-adjusted multivariable analysis revealed that the freedom rates from cardiac death were higher in the TAP group than in the TVR group (P = 0.01). In the propensity score-matched patients, the freedom rates from cardiac death and tricuspid valve-related event were higher in the TAP group than in the TVR group, although the difference was not statistically significant.
TAP should be considered as a treatment of choice for patients with severe FTR because TVR has been associated with long-term cardiac death and valve-related events.
既往研究比较了功能性二尖瓣反流患者二尖瓣环成形术与二尖瓣置换术的疗效。然而，关于功能性三尖瓣反流（FTR）患者三尖瓣环成形术（TAP）与三尖瓣置换术（TVR）结果比较的数据较少。我们评估了TAP是否是重度FTR的最佳选择。
1996年至2012年，175例（57±11岁）患者接受了重度FTR的手术矫正。其中108例患者接受了TAP（TAP组），67例接受了TVR（TVR组）。进行治疗权重逆概率（IPTW）分析，并对每组37例患者进行倾向评分匹配，以调整两组之间的基线差异。
13例患者发生早期死亡，两组之间无差异。有35例晚期死亡，包括24例心源性死亡。TAP组心脏死亡的5年和10年无事件生存率分别为93.0%和88.5%，TVR组分别为84.7%和69.8%。IPTW调整后的多变量分析显示，TAP组心脏死亡的无事件生存率高于TVR组（P = 0.01）。在倾向评分匹配的患者中，TAP组心脏死亡和三尖瓣相关事件的无事件生存率高于TVR组，尽管差异无统计学意义。
对于重度FTR患者，应考虑将TAP作为首选治疗方法，因为TVR与长期心源性死亡和瓣膜相关事件有关。
