Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Korea.
Eur J Cardiothorac Surg. 2018 Apr 1;53(4):756-763. doi: 10.1093/ejcts/ezx395.
The benefits of concomitant tricuspid annuloplasty (TAP) for non-significant functional tricuspid regurgitation (TR) during mitral valve replacement (MVR) are controversial. We evaluated the long-term outcomes-particularly the long-term tricuspid valve (TV) functional outcomes-of MVR with or without tricuspid ring annuloplasty.
From 2004 to 2014, 256 patients (56.4 ± 12.1 years) with trivial or mild functional TR who underwent MVR were enrolled. Eighty-two patients underwent concomitant tricuspid ring annuloplasty (TAP group), and 174 patients did not undergo the TV procedure (nTAP group). Propensity score-matched analysis was performed (n = 72 in each group). The follow-up duration was 77.4 ± 42.4 months.
The early clinical outcomes were similar between the 2 groups before and after propensity score matching with an early mortality rate of 3.5% (9 of 256). No patients experienced ring-related complications during follow-up. Eleven (6.3%) patients developed significant TR (≥moderate) in the nTAP group, while no patients developed significant TR in the TAP group. There were no significant differences in overall survival between the 2 groups before or after matching. However, propensity score-matched analysis revealed that the freedom from significant TR aggravation and freedom from TV-related event rates were significantly higher in the TAP group than in the nTAP group (P = 0.047 and P = 0.043, respectively).
Patients with untreated trivial or mild functional TR accompanied by mitral valve disease can develop significant TR during follow-up. TV ring annuloplasty can be performed without complications and can be beneficial for patients with trivial or mild functional TR who are undergoing MVR.
在二尖瓣置换术（MVR）期间同期行三尖瓣环成形术（TAP）治疗非重度功能性三尖瓣反流（TR）的获益仍存在争议。我们评估了 MVR 同期或非同期行三尖瓣环成形术的长期结果，尤其是长期三尖瓣（TV）功能结局。
2004 年至 2014 年，我们纳入了 256 例（56.4±12.1 岁）行 MVR 的轻或中度功能性 TR 患者。82 例行同期三尖瓣环成形术（TAP 组），174 例未行 TV 手术（nTAP 组）。采用倾向评分匹配分析（每组 n=72）。随访时间为 77.4±42.4 个月。
两组患者在倾向评分匹配前后的早期临床结局相似，早期死亡率为 3.5%（256 例中 9 例）。随访期间无患者发生环相关并发症。nTAP 组中有 11 例（6.3%）患者发生重度 TR（≥中度），而 TAP 组中无患者发生重度 TR。两组患者在匹配前后的总生存率无显著差异。然而，倾向评分匹配分析显示，TAP 组患者中重度 TR 加重和 TV 相关事件的无事件生存率明显高于 nTAP 组（P=0.047 和 P=0.043）。
伴有二尖瓣疾病的未治疗轻或中度功能性 TR 患者在随访过程中可能会发展为重度 TR。TV 环成形术可以安全进行，并且对于行 MVR 的轻或中度功能性 TR 患者可能有益。
