Department of Surgery, University of Virginia, Charlottesville, Virginia.
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Ann Thorac Surg. 2018 Jul;106(1):129-136. doi: 10.1016/j.athoracsur.2017.11.077. Epub 2018 Feb 2.
Although tricuspid valve operations remain associated with high mortality (approximately 8% to 10%), no robust prediction models exist to support clinical decision making. We developed a preoperative clinical risk model with an easily calculable clinical risk score (CRS) to predict mortality and major morbidity after isolated tricuspid valve surgery.
The Society of Thoracic Surgeons database records were evaluated for 2,050 isolated TV repair and replacement operations for any etiology performed at 50 hospitals (2002 to 2014) in a number of states. Parsimonious preoperative risk prediction models were developed using multiple-level mixed effects regression to estimate mortality and composite major morbidity risk. Model results were utilized to establish a novel CRS for patients undergoing tricuspid valve operations. Models were evaluated for discrimination and calibration.
Operative mortality and composite major morbidity rates were 9% and 42%, respectively. Final regression models performed well (both p < 0.001; areas under the receiver-operating characteristics curve 0.74 and 0.76) and included preoperative factors: age, sex, stroke, hemodialysis, ejection fraction, lung disease, New York Heart Association class, reoperation, and urgent or emergency status (all p < 0.05). A simple CRS from 0 to 10+ was highly associated (p < 0.001) with incremental increases in predicted mortality and major morbidity. Predicted mortality risk ranged from 2% to 34% across CRS categories, and predicted major morbidity risk ranged from 13% to 71%.
Mortality and major morbidity after isolated tricuspid valve surgery can be predicted using preoperative patient data from The Society of Thoracic Surgeons National Adult Cardiac Database. A simple clinical risk score predicts mortality and major morbidity after isolated tricuspid valve surgery. This score may facilitate perioperative counseling and identification of suitable patients for tricuspid valve surgery.
尽管三尖瓣手术仍然与高死亡率（约 8%至 10%）相关，但目前尚无强大的预测模型来支持临床决策。我们开发了一种术前临床风险模型，该模型具有易于计算的临床风险评分（CRS），可预测孤立性三尖瓣手术后的死亡率和主要发病率。
评估了 50 家医院（2002 年至 2014 年）在多个州进行的 2050 例孤立性 TV 修复和置换手术的胸外科医生协会数据库记录，这些手术适用于任何病因。使用多级混合效应回归来开发简约的术前风险预测模型，以估计死亡率和复合主要发病率风险。模型结果用于为接受三尖瓣手术的患者建立新的 CRS。评估模型的区分度和校准度。
手术死亡率和复合主要发病率分别为 9%和 42%。最终回归模型表现良好（p<0.001；接受者操作特征曲线下面积分别为 0.74 和 0.76），并包括术前因素：年龄、性别、中风、血液透析、射血分数、肺部疾病、纽约心脏协会分级、再次手术以及紧急或紧急情况（均 p<0.05）。从 0 到 10+的简单 CRS 与预测死亡率和主要发病率的递增高度相关（p<0.001）。预测死亡率风险范围从 CRS 类别中的 2%到 34%，预测主要发病率风险范围从 13%到 71%。
使用胸外科医生协会国家成人心脏数据库的术前患者数据，可以预测孤立性三尖瓣手术后的死亡率和主要发病率。简单的临床风险评分可预测孤立性三尖瓣手术后的死亡率和主要发病率。该评分可促进围手术期咨询并确定适合三尖瓣手术的患者。
