Thoraxcenter, Department of Cardiothoracic Surgery, Erasmus University Medical Centre, Rotterdam, Netherlands.
Thoraxcenter, Department of Cardiology, Erasmus University Medical Centre, Rotterdam, Netherlands.
Eur J Cardiothorac Surg. 2018 Oct 1;54(4):644-651. doi: 10.1093/ejcts/ezy150.
Moderate-to-severe tricuspid regurgitation is common in end-stage heart disease and is associated with an impaired survival after left ventricular assist device (LVAD) surgery. Controversy remains whether concomitant tricuspid valve surgery (TVS) during LVAD implantation is beneficial. We aimed to provide a contemporary overview of outcomes in patients who underwent LVAD surgery with or without concomitant TVS.
A systematic literature search was performed for articles published between January 2005 and March 2017. Studies comparing patients undergoing isolated LVAD implantation and LVAD + TVS were included. Early outcomes were pooled in risk ratios using random effects models, and late survival was visualized by a pooled Kaplan-Meier curve.
Eight publications were included in the meta-analysis, including 562 undergoing isolated LVAD implantation and 303 patients with LVAD + TVS. Patients undergoing LVAD + TVS had a higher tricuspid regurgitation grade, central venous pressure and bilirubin levels at baseline and were more often female. We found no significant differences in early mortality and late mortality, early right ventricular failure and late right ventricular failure, acute kidney failure, early right ventricular assist device implantation or length of hospital stay. Cardiopulmonary bypass time was longer in patients undergoing additional TVS [mean difference +35 min 95% confidence interval (16-55), P = 0.001].
Adding TVS during LVAD implantation is not associated with worse outcome. Adding TVS, nevertheless, may be beneficial, as baseline characteristics of patients undergoing LVAD + TVS were suggestive of a more progressive underlying disease, but with comparable short-term outcome and long-term outcome with patients undergoing isolated LVAD.
三尖瓣中重度反流在终末期心脏病中很常见，并且与左心室辅助装置（LVAD）手术后的生存预后不良相关。在 LVAD 植入术中同时进行三尖瓣手术（TVS）是否有益仍存在争议。我们旨在提供在接受 LVAD 手术伴或不伴同期 TVS 的患者的当代结局概述。
对 2005 年 1 月至 2017 年 3 月期间发表的文章进行了系统的文献检索。纳入比较单纯 LVAD 植入术和 LVAD+TVS 患者的研究。使用随机效应模型汇总早期结果的风险比，并用汇总 Kaplan-Meier 曲线显示晚期生存情况。
共有 8 篇文献纳入荟萃分析，包括 562 例接受单纯 LVAD 植入术和 303 例接受 LVAD+TVS 的患者。接受 LVAD+TVS 的患者三尖瓣反流程度更高，基线时中心静脉压和胆红素水平更高，且女性更多。我们未发现早期死亡率和晚期死亡率、早期右心室衰竭和晚期右心室衰竭、急性肾衰竭、早期右心室辅助装置植入或住院时间的显著差异。行额外 TVS 的患者体外循环时间更长[平均差值+35 分钟 95%置信区间（16-55），P=0.001]。
在 LVAD 植入术中增加 TVS 并不与更差的结局相关。尽管如此，增加 TVS 可能是有益的，因为接受 LVAD+TVS 的患者的基线特征提示存在更具进展性的潜在疾病，但短期和长期结局与接受单纯 LVAD 的患者相似。
