Zhu Tie-Yuan, Wang Jian-Gang, Meng Xu
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
Interact Cardiovasc Thorac Surg. 2015 Jan;20(1):114-8. doi: 10.1093/icvts/ivu326. Epub 2014 Sep 26.
A best evidence topic in adult valvular surgery was written according to a structured protocol. The question addressed was 'Does concomitant tricuspid annuloplasty increase the perioperative mortality and morbidity when correcting left-sided valve disease?' A total of 561 papers were found using the reported search, of which 12 presented the best evidence to answer the clinical question. The authors, country, journal, date of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Among these 12 papers, there were nine retrospective studies, two cohort studies and one randomized controlled trial (RCT). Overall, additional tricuspid valve (TV) repair takes more time during operations, particularly with a ring annuloplasty method. The mean aortic cross-clamping times were 57-83 min without associated tricuspid repair and 62-100 min with, and cardiopulmonary bypass times without and with repair were 82-124 and 90-174 min, respectively. A study of 624 patients who had undergone isolated mitral valve (MV) surgery and MV surgery plus TV repair showed more female and atrial fibrillation patients in the tricuspid valve plasty (TVP) group, but no increase in the 30-day mortality was found. One RCT, presenting similar patient baseline characteristics, also found no difference in the hospital mortality rates between the TVP group and the non-TVP group. Another 10 studies also demonstrated no statistically significant differences in perioperative mortality. In a cohort study of 311 patients undergoing MV repair with or without tricuspid annuloplasty, postoperative complications, such as bleeding, stroke, pacemaker, haemofiltration and myocardial infarction, all showed no statistically significant differences in the two groups. One study retrospectively analysed a large number of patients undergoing either isolated left-sided valve surgery or a concomitant TV repair, and there were no statistically significant differences regarding major complications (bleeding, pacemaker, respiratory insufficiency, and renal failure). Moreover, another three studies also found no statistically significant differences in terms of bleeding, pacemaker, wound infection, neurological deficit, pericardial effusion, low cardiac output syndrome and dialysis. In conclusion, there is good evidence to support that tricuspid annuloplasty is a low-risk procedure and concomitant TV repair does not significantly increase the perioperative mortality and morbidity when correcting left-sided valve disease.
一篇关于成人心脏瓣膜手术的最佳证据主题文章是按照结构化方案撰写的。所探讨的问题是“在纠正左侧瓣膜疾病时，同期进行三尖瓣环成形术是否会增加围手术期死亡率和发病率？”通过报告的检索共找到561篇论文，其中12篇提供了回答该临床问题的最佳证据。这些论文的作者、国家、期刊、发表日期、研究的患者群体、研究类型、相关结局和结果均列于表格中。在这12篇论文中，有9篇回顾性研究、2篇队列研究和1篇随机对照试验（RCT）。总体而言，额外进行三尖瓣（TV）修复在手术过程中会花费更多时间，尤其是采用环成形术方法时。在未进行相关三尖瓣修复的情况下，平均主动脉阻断时间为57 - 83分钟，进行修复时为62 - 100分钟，未修复和修复时的体外循环时间分别为82 - 124分钟和90 - 174分钟。一项对624例接受单纯二尖瓣（MV）手术以及MV手术加TV修复的患者的研究表明，三尖瓣成形术（TVP）组女性和房颤患者更多，但未发现30天死亡率增加。一项具有相似患者基线特征的RCT也发现TVP组和非TVP组的医院死亡率无差异。另外10项研究也表明围手术期死亡率无统计学显著差异。在一项对311例接受有或无三尖瓣环成形术的MV修复患者的队列研究中，术后并发症，如出血、中风、起搏器植入、血液滤过和心肌梗死，两组均无统计学显著差异。一项研究回顾性分析了大量接受单纯左侧瓣膜手术或同期TV修复的患者，在主要并发症（出血、起搏器植入、呼吸功能不全和肾衰竭）方面无统计学显著差异。此外，另外三项研究在出血、起搏器植入、伤口感染、神经功能缺损、心包积液、低心排血量综合征和透析方面也未发现统计学显著差异。总之，有充分证据支持三尖瓣环成形术是一种低风险手术，并且在纠正左侧瓣膜疾病时同期进行TV修复不会显著增加围手术期死亡率和发病率。
