Cardiac Surgery Department, S.Orsola Hospital, University of Bologna.
Department of Clinical Governance, Emilia-Romagna Agency for Health and Social Care, Bologna.
J Cardiovasc Med (Hagerstown). 2018 Jul;19(7):382-388. doi: 10.2459/JCM.0000000000000665.
Triple valve surgery (TVS) may still be considered a challenge in cardiac surgery, and is still associated with a not negligible mortality and morbidity. This study analyzed retrospectively patients' data from RERIC (Registro Regionale degli Interventi Cardiochirurgici) registry, to evaluate early and mid-term results of TVS.
From April 2002 to December 2013, data from n = 44 211 cardiac surgical procedures were collected from six Cardiac Surgery Departments (RERIC). Two hundred and eighty patients undergoing TVS were identified, including aortic and mitral replacement with tricuspid repair in 211 patients (75.3%), aortic replacement with mitral and tricuspid repair in 64 (22.9%) and triple valve replacement in 5 (1.8%). Univariate and multivariate analyses were performed to identify predictors of overall mortality or adverse outcomes.
The mean age of the patients was 67.5 ± 12.2. Overall in-hospital mortality rate was 7.9%: in-hospital mortality was 10.9% in mitral valve repair and 6.6% in mitral valve replacement, respectively. Tricuspid valve replacement was associated with the highest mortality rate (40%). Independent predictors of in-hospital mortality were serum creatinine greater than 2 mg/dl [odds ratio (OR) 4.5; P = 0.03], concomitant coronary artery bypass graft (CABG) (OR 3.8; P = 0.01) and previous cardiac surgery (OR 5.1; P = 0.04). Overall cumulative mortality rate at 1, 3 and 5 years was 14.7, 24.1 and 28.9%, respectively. Mitral valve replacement associated with tricuspid valve repair showed better survival rate (hazard ratio 0.1; P = 0.007).
TVS has demonstrated satisfactory results in terms of in-hospital and mid-term mortality rate. Renal failure, reoperations and concomitant CABG resulted as risk factors for mortality; moreover, we could not demonstrate a mid-term better survival rate of mitral valve repair compared with the replacement.
三尖瓣手术（TVS）在心脏外科中仍被认为是一个挑战，并且仍然与不可忽视的死亡率和发病率相关。本研究回顾性分析了 RERIC（意大利心脏手术登记处）登记处患者的数据，以评估 TVS 的早期和中期结果。
从 2002 年 4 月至 2013 年 12 月，从六个心脏外科部门（RERIC）收集了 44211 例心脏手术的数据。确定了 280 例接受 TVS 的患者，其中 211 例（75.3%）进行了主动脉瓣和二尖瓣置换及三尖瓣修复，64 例（22.9%）进行了主动脉瓣置换及二尖瓣和三尖瓣修复，5 例（1.8%）进行了三尖瓣置换。进行了单变量和多变量分析，以确定总体死亡率或不良结果的预测因素。
患者的平均年龄为 67.5±12.2 岁。总体住院死亡率为 7.9%：二尖瓣修复的住院死亡率为 10.9%，二尖瓣置换的住院死亡率为 6.6%。三尖瓣置换的死亡率最高（40%）。住院死亡率的独立预测因素包括血清肌酐大于 2mg/dl[比值比（OR）4.5；P=0.03]、同时行冠状动脉旁路移植术（CABG）（OR 3.8；P=0.01）和既往心脏手术（OR 5.1；P=0.04）。1、3 和 5 年的总累积死亡率分别为 14.7%、24.1%和 28.9%。二尖瓣置换伴三尖瓣修复的生存率较好（风险比 0.1；P=0.007）。
TVS 在住院和中期死亡率方面表现出令人满意的结果。肾功能衰竭、再次手术和同时行 CABG 是死亡的危险因素；此外，我们不能证明与置换相比，二尖瓣修复的中期生存率更好。
