Department of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China.
Eur J Cardiothorac Surg. 2018 May 1;53(5):1034-1039. doi: 10.1093/ejcts/ezx453.
Tricuspid valve reoperation (TVR) following left-sided valve surgery (LSVS) is a high-risk procedure. This study was conducted to analyse the mid-term results and risks of isolated TVR following LSVS.
From May 2007 to December 2016, 91 patients who underwent isolated TVR following LSVS were enrolled in this study.
The patients comprised 23 men and 68 women with a mean age of 57.5 ± 8.0 years (range 33-75 years). The in-hospital mortality rate was 2.2% (2 of 91 patients). Fourteen (15.4%) procedures were performed through a median sternotomy, whereas 77 (84.6%) were performed through a right thoracotomy. One patient underwent tricuspid valve repair, while the others underwent valve replacement including 16 (17.6%) cases involving mechanical valves and 74 (81.3%) involving tissue valves. Eight (9.0%) deaths occurred during the follow-up at 9.21 ± 18.8 months (range 1-108 months), including 5 cardiac deaths. The Kaplan-Meier survival rates at 1 year and 5 years were 97.7% and 90.0%, respectively. Previous aortic and mitral valve replacement [odds ratio (OR) 0.161, P = 0.0015], preoperative central venous pressure (OR 1.202, P = 0.0353), pulmonary artery pressure (OR 1.075, P = 0.0134) and left ventricular end-systolic diameter (OR 1.13, P = 0.0155) were the risk factors for a longer intensive care duration. The valve type had no significant effect on the survival of patients who had undergone valve replacement.
Isolated TVR is a safe and effective surgery for tricuspid valve lesions following LSVS, and right thoracotomy may be a reasonable choice.
左心瓣膜手术后再次行三尖瓣手术（TVR）是一种高风险的操作。本研究旨在分析左心瓣膜手术后再次行单纯 TVR 的中期结果和风险。
自 2007 年 5 月至 2016 年 12 月，共纳入 91 例行单纯 TVR 的左心瓣膜手术后患者。
患者中男性 23 例，女性 68 例，平均年龄 57.5±8.0 岁（33-75 岁）。院内死亡率为 2.2%（2/91 例）。14 例（15.4%）经正中开胸完成手术，77 例（84.6%）经右胸入路完成手术。1 例患者行三尖瓣修复术，其余患者行瓣膜置换术，其中 16 例（17.6%）采用机械瓣，74 例（81.3%）采用生物瓣。随访 9.21±18.8 个月（1-108 个月）期间死亡 8 例（9.0%），其中 5 例为心源性死亡。1 年和 5 年的 Kaplan-Meier 生存率分别为 97.7%和 90.0%。既往主动脉瓣和二尖瓣置换术（比值比 0.161，P=0.0015）、术前中心静脉压（比值比 1.202，P=0.0353）、肺动脉压（比值比 1.075，P=0.0134）和左心室收缩末期直径（比值比 1.13，P=0.0155）是 ICU 时间延长的危险因素。瓣膜类型对行瓣膜置换术患者的生存无显著影响。
左心瓣膜手术后再次行单纯 TVR 是一种安全有效的手术方法，右胸入路可能是一种合理的选择。
