Fukunaga Naoto, Koyama Tadaaki
Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Ann Thorac Cardiovasc Surg. 2019 Apr 20;25(2):111-116. doi: 10.5761/atcs.oa.18-00195. Epub 2018 Nov 28.
Isolated tricuspid valve surgery (TVS) following valvular surgery has been still challenging. We reviewed our experience to determine early and late outcomes.
We retrospectively analyzed 14 patients (mean age, 57.0 ± 17.8 years old) who underwent isolated TVS after valvular surgery between January 1990 and December 2010. The causes of isolated TVS were structural valve deterioration (SVD) (n = 5) and symptomatic severe tricuspid regurgitation (n = 9). The mean follow-up period was 6.4 ± 5.9 years.
At redo, seven patients underwent tricuspid valve replacement (TVR) using a bioprosthesis and the remaining underwent tricuspid valve repair (TVP). Early mortality rate was 7.1% (1/14). Survival rates at 5 and 10 years were 68.8% ± 13.1% and 68.8% ± 13.1%, respectively. Three deaths (two for heart failure and one for cerebral hemorrhage) were observed. Freedom from valve-related events was 58.3% ± 14.2% at 2 and 48.6% ± 14.8% at 5 years. Six events were observed (five for heart failure and one for cerebral hemorrhage). There was no statistically significant difference between TVP and TVR as to freedom from valve-related events (log-rank p = 0.3655).
Early and late outcomes of isolated TVS after valvular surgery seem to be satisfactory. Special attention should be paid to heart failure following TVP.
瓣膜手术后单纯三尖瓣手术（TVS）仍具有挑战性。我们回顾了我们的经验以确定早期和晚期结果。
我们回顾性分析了1990年1月至2010年12月期间在瓣膜手术后接受单纯TVS的14例患者（平均年龄57.0±17.8岁）。单纯TVS的病因包括人工瓣膜结构性退变（SVD）（n = 5）和有症状的严重三尖瓣反流（n = 9）。平均随访时间为6.4±5.9年。
再次手术时，7例患者使用生物瓣进行了三尖瓣置换（TVR），其余患者接受了三尖瓣修复（TVP）。早期死亡率为7.1%（1/14）。5年和10年生存率分别为68.8%±13.1%和68.8%±13.1%。观察到3例死亡（2例死于心力衰竭，1例死于脑出血）。2年时无瓣膜相关事件生存率为58.3%±14.2%，5年时为48.6%±14.8%。观察到6例事件（5例因心力衰竭，1例因脑出血）。在无瓣膜相关事件方面，TVP和TVR之间无统计学显著差异（对数秩检验p = 0.3655）。
瓣膜手术后单纯TVS的早期和晚期结果似乎令人满意。TVP后应特别关注心力衰竭。
