Chang Hyoung Woo, Jeong Dong Seop, Cho Yang Hyun, Sung Kiick, Kim Wook Sung, Lee Young Tak, Park Pyo Won
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
Circ J. 2017 Feb 24;81(3):330-338. doi: 10.1253/circj.CJ-16-0961. Epub 2016 Dec 27.
The aim of this study was to compare early and late outcomes of tricuspid valve replacement (TVR) and tricuspid valve repair (TVr) for severe tricuspid regurgitation (TR).
From 1994 to 2012, 360 patients (mean age, 58±13 years) with severe TR underwent TVR (n=97, 27%) or TVr (n=263, 73%). Among them, 282 patients (78%) had initial rheumatic etiology, and 307 patients (85%) had preoperative atrial fibrillation. The TVR group had higher total bilirubin, higher baseline central venous pressure, and higher incidence of previous cardiac operation. There was no difference in early mortality (TVR:TVr, 3.1%:3.4%, P=0.877). Ten-year overall survival (TVR:TVr, 72%:70%, P=0.532) and 10-year freedom from cardiac death (TVR:TVr, 76%:77%, P=0.715) were not significantly different between groups. After applying stabilized inverse probability of treatment weighting methods, there were still no significant differences in early mortality (P=0.293), overall survival (P=0.649) or freedom from cardiac death (P=0.870). Higher NYHA functional class, total bilirubin (>2 mg/dL), initial central venous pressure, and cardiopulmonary bypass time were independent predictors of early mortality. Older age, LV dysfunction (EF <40%), and hemoglobin <10 g/dL were independent predictors of late cardiac mortality.
Compared with TVr, TVR had acceptable early and late outcomes in patients with severe TR. TVR can be considered as a valid option with acceptable clinical outcomes in patients who are not suitable candidates for TVr.
本研究旨在比较严重三尖瓣反流（TR）患者行三尖瓣置换术（TVR）和三尖瓣修复术（TVr）的早期和晚期结果。
1994年至2012年，360例严重TR患者（平均年龄58±13岁）接受了TVR（n = 97，27%）或TVr（n = 263，73%）。其中，282例患者（78%）最初病因是风湿性，307例患者（85%）术前有房颤。TVR组总胆红素更高、基线中心静脉压更高、既往心脏手术发生率更高。早期死亡率无差异（TVR:TVr，3.1%:3.4%，P = 0.877）。两组间10年总生存率（TVR:TVr，72%:70%，P = 0.532）和10年无心脏死亡生存率（TVR:TVr，76%:77%，P = 0.715）无显著差异。应用稳定的治疗权重逆概率方法后，早期死亡率（P = 0.293）、总生存率（P = 0.649）或无心脏死亡生存率（P = 0.870）仍无显著差异。纽约心脏协会（NYHA）功能分级更高、总胆红素（>2mg/dL）、初始中心静脉压和体外循环时间是早期死亡率的独立预测因素。年龄较大、左心室功能障碍（射血分数<40%）和血红蛋白<10g/dL是晚期心脏死亡的独立预测因素。
与TVr相比，TVR在严重TR患者中具有可接受的早期和晚期结果。对于不适合TVr的患者，TVR可被视为一种具有可接受临床结果的有效选择。
