De Meester Pieter, De Cock Dries, Van De Bruaene Alexander, Gabriels Charlien, Buys Roselien, Helsen Frederik, Voigt Jens-Uwe, Herijgers Paul, Herregods Marie-Christine, Budts Werner
Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium.
Heart. 2015 May;101(9):720-6. doi: 10.1136/heartjnl-2014-306801. Epub 2015 Feb 20.
The clinical benefit of tricuspid annuloplasty (TA) in patients undergoing mitral valve surgery (MVS) is still debated. We evaluated the immediate surgical success, postoperative outcome and the medium-term effect of TA in MVS.
Patients were included between September 2003 and December 2009 and followed until September 2013 to achieve a median follow-up time of 5 years (IQR 3.7-6.9). The end point of mortality due to cardiac causes and combined end point of cardiac mortality or hospitalisation for heart failure were evaluated. Propensity score adjusted Cox regression was used to evaluate the clinical benefit of TA at the time of MVS.
Of 150 patients (84 female; 67±12 years), 82 presented with tricuspid regurgitation (TR) <2/4 and underwent isolated MVS. Of 68 patients presenting with TR≥2/4, 31 underwent isolated MVS whereas 37 underwent additional TA. In patients with preoperative TR≥2/4, TR was significantly reduced until 5 years postoperatively (mean reduction 0.81±1.31; p=0.04) when additional TA was done. The combined end point occurred in 29% vs 6% at 1 year and in 57% vs 39% at 5 years follow-up for patients with isolated MVS and patients undergoing concomitant TA, respectively. Patients with preoperative TR≥2/4 had worse unadjusted survival than those with TR<2/4 (logrank p=0.009). In the patients with TR≥2/4, propensity score-adjusted risk for the combined end point was higher in those with isolated MVS versus MVS with additional TA (Cox HR 2.855 (1.082-7.532), p=0.035).
Additional TA is an effective surgical measure to reduce functional TR severity. This approach results in a decreased risk of cardiac mortality and hospitalisation in patients with preoperative TR≥2/4.
二尖瓣手术（MVS）患者行三尖瓣环成形术（TA）的临床益处仍存在争议。我们评估了TA在MVS中的手术即刻成功率、术后结局及中期效果。
纳入2003年9月至2009年12月期间的患者，并随访至2013年9月，以获得中位随访时间5年（四分位间距3.7 - 6.9年）。评估心源性死亡终点以及心脏死亡或因心力衰竭住院的复合终点。采用倾向评分调整的Cox回归评估TA在MVS时的临床益处。
150例患者（84例女性；67±12岁）中，82例三尖瓣反流（TR）<2/4，接受单纯MVS。68例TR≥2/4的患者中，31例接受单纯MVS，37例同时接受TA。术前TR≥2/4的患者，在接受额外TA后，术后5年TR显著降低（平均降低0.81±1.31；p = 0.04）。单纯MVS患者和同时接受TA的患者在1年时复合终点发生率分别为29%和6%，5年随访时分别为57%和39%。术前TR≥2/4的患者未经调整的生存率低于TR<2/4的患者（logrank p = 0.009）。在TR≥2/4的患者中，单纯MVS患者与接受额外TA治疗的MVS患者相比，复合终点的倾向评分调整风险更高（Cox风险比2.855（1.082 - 7.532），p = 0.035）。
额外的TA是降低功能性TR严重程度的有效手术措施。该方法可降低术前TR≥2/4患者的心源性死亡和住院风险。
