Dhoble Abhijeet, Zhao Yelin, Vejpongsa Pimprapa, Loghin Catalin, Smalling Richard W, Estrera Anthony, Nguyen Tom C
McGovern School of Medicine, University of Texas, Houston, TX, USA -
Memorial Hermann Heart and Vascular Center, Texas Medical Center, Houston, TX, USA -
J Cardiovasc Surg (Torino). 2019 Feb;60(1):119-127. doi: 10.23736/S0021-9509.18.10468-X. Epub 2018 Jul 3.
The data on the trends and comparative outcomes after isolated and concomitant tricuspid valve repair/replacement (TVR) is scarce.
The International Classification of Diseases - 9th version was used to identify the patients who underwent TVR, using the National Inpatient Sample. Outcomes were evaluated using the analysis of variance and Chi-square test, and trends across the years were tested via Cochran-Armitage Test.
Of 6868 patients who underwent TVR between 2005-14, 1601 (23%) were isolated. Over the 10-years period, the number of total and isolated TVR has steadily increased (P<0.001). The proportion of patients undergoing repair has increased compared to replacement. Overall in-hospital mortality was 8.5% and 7.7% (p=0.28), permanent pacemaker requirement was 11.24% and 10.69% (P=0.53), blood transfusion rates were 32.6% and 37.9% (P<0.001), and the post-procedure length of stay (LOS) was 14.1±0.44 and 12.5±0.17 days (P<0.001) after isolated and concomitant TVR respectively. High (26.25%) number of patients were discharged to skilled facility. The operative mortality associated with TV repair was lower than with replacement (6.8% versus 11.15%, P<0.001), but the mortality trend over the 10-years has stayed relatively stable. Independent predictors of mortality were age >50 years, heart failure, cerebrovascular accident, end-stage renal disease, peripheral vascular disease, liver disease, and TV replacement.
Both isolated and concomitant TVR has increased over the last 10 years, however is associated with high mortality, complications, need for skilled facility placement, and longer LOS. The mortality after TV replacement was significantly higher than that after repair.
关于单纯及同期三尖瓣修复/置换术（TVR）后的趋势及比较结果的数据较少。
使用国际疾病分类第九版，通过国家住院患者样本识别接受TVR的患者。采用方差分析和卡方检验评估结果，并通过 Cochr an - Armitage检验检测多年来的趋势。
在2005年至2014年间接受TVR的6868例患者中，1601例（23%）为单纯手术。在这10年期间，总的和单纯TVR的数量稳步增加（P<0.001）。与置换相比，接受修复的患者比例有所增加。总体住院死亡率分别为8.5%和7.7%（p = 0.28），永久起搏器植入率分别为11.24%和10.69%（P = 0.53），输血率分别为32.6%和37.9%（P<0.001），单纯和同期TVR术后的住院时间分别为14.1±0.44天和12.5±0.17天（P<0.001）。大量患者（26.25%）出院后进入专业护理机构。与三尖瓣修复相关的手术死亡率低于置换术（6.8%对11.15%，P<0.001），但10年来的死亡率趋势相对稳定。死亡率的独立预测因素包括年龄>50岁、心力衰竭、脑血管意外、终末期肾病、外周血管疾病、肝脏疾病和三尖瓣置换。
在过去10年中，单纯及同期TVR均有所增加，但与高死亡率、并发症、进入专业护理机构的需求以及更长的住院时间相关。三尖瓣置换后的死亡率显著高于修复术后。
