Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy.
Department of Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Milan, Italy.
Eur J Cardiothorac Surg. 2017 Jul 1;52(1):125-130. doi: 10.1093/ejcts/ezx027.
To report the long-term results of the clover technique for the treatment of complex forms of tricuspid regurgitation (TR).
Ninety-six consecutive patients (mean age 60 ± 16.4, left ventricular ejection fraction 58 ± 8.8%) with severe or moderately-severe TR due to important leaflets prolapse/flail (81 patients), tethering (13 patients) or mixed (2 patients) lesions underwent clover repair combined with annuloplasty. The aetiology of TR was degenerative in 74 cases (77.1%), post-traumatic in 9 (9.4%) and secondary to dilated cardiomyopathy in 13 (13.5%). All patients but 3 (96.8%) underwent ring (59 patients, 61.5%) or suture (34 patients, 35.4%) annuloplasty. Concomitant procedures (mainly mitral surgery) were performed in 82 patients (85.4%).
Hospital mortality was 7.2%. At hospital discharge 92 (95.8%) patients had no or mild TR. Follow-up was 98% complete (median 9 years, interquartile range 5.1; 10.9). At 12 years the overall survival was 71.6 ± 7.22% and the cumulative incidence function of cardiac death with non-cardiac death as competing risk 16 ± 4.1% [95% confidence interval (95% CI) 9.5-25.7]. At 12 years the cumulative incidence function of TR ≥ 3+ and TR ≥ 2+ with death as competing risk were 1.2 ± 1.2% (95% CI 0.1-5.8) and 28 ± 7.7% (95% CI 14.3-43.5), respectively. Preoperative left ventricular ejection fraction (hazard ratio 0.9, CI 0.9-1, P = 0.05) and previous cardiac surgery (hazard ratio 2.7, 95% CI 1-7.1, P = 0.03) were predictors of recurrent TR ≥ 2+ at univariable but not at multivariable analysis.
Complex forms of TR due to severe prolapse or tethering of the leaflets can be effectively treated with the clover technique with very satisfactory long-term results and extremely low recurrence of severe TR.
报告三尖瓣反流（TR）复杂形式的三叶草技术治疗的长期结果。
96 例连续患者（平均年龄 60±16.4，左心室射血分数 58±8.8%）因重要瓣叶脱垂/连枷（81 例）、牵张（13 例）或混合（2 例）病变而出现严重或中度严重 TR，接受三叶草修复联合瓣环成形术。TR 的病因在 74 例（77.1%）中为退行性，9 例（9.4%）为创伤后，13 例（13.5%）为扩张型心肌病。除 3 例（96.8%）患者（96.8%）接受环（59 例，61.5%）或缝线（34 例，35.4%）瓣环成形术外，所有患者均接受环（59 例，61.5%）或缝线（34 例，35.4%）瓣环成形术。82 例（85.4%）患者同时进行了其他手术（主要为二尖瓣手术）。
住院死亡率为 7.2%。出院时 92 例（95.8%）患者无或轻度 TR。随访 98%完整（中位随访 9 年，四分位间距 5.1；10.9）。12 年总生存率为 71.6±7.22%，以非心脏死亡为竞争风险的心脏死亡累积发生率为 16±4.1%[95%置信区间（95%CI）9.5-25.7]。12 年时，以死亡为竞争风险的 TR≥3+和 TR≥2+的累积发生率分别为 1.2±1.2%（95%CI 0.1-5.8）和 28±7.7%（95%CI 14.3-43.5）。术前左心室射血分数（风险比 0.9，95%CI 0.9-1，P=0.05）和既往心脏手术（风险比 2.7，95%CI 1-7.1，P=0.03）是单变量分析中复发性 TR≥2+的预测因素，但在多变量分析中不是。
严重瓣叶脱垂或牵张的复杂形式 TR 可通过三叶草技术有效治疗，长期效果非常满意，严重 TR 复发率极低。
