Department of Cardiothoracic Surgery, Thoraxcenter, Rg-619, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
Department of Cardiology, Thoraxcenter, Rg-619, Erasmus MC, University Medical Center Rotterdam, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands.
Eur Heart J Qual Care Clin Outcomes. 2020 Jan 1;6(1):10-18. doi: 10.1093/ehjqcco/qcz032.
This study aims to provide a contemporary overview of outcomes after tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR).
The literature was systematically searched for papers published between January 2005 and December 2017 reporting on clinical/echocardiographic outcomes after TV surgery for functional TR. A random effects meta-analysis was conducted for outcome variables, and late outcomes are visualized by pooled Kaplan-Meier curves. Subgroup analyses were performed for studies with a within-study comparison of suture vs. ring repair and flexible vs. rigid ring repair. Eighty-seven publications were included, encompassing 13 184 patients (mean age: 62.1 ± 11.8 years, 55% females). A mitral valve procedure was performed in 92% of patients. Pooled mean follow-up was 4.0 ± 2.8 years. Pooled early mortality was 3.9% (95% CI: 3.2-4.6), and late mortality rate was 2.7%/year (95% CI: 2.0-3.5), of which approximately half was cardiac-related 1.2%/year (95% CI: 0.8-1.9). Pooled risk of early moderate-to-severe TR at discharge was 9.4% (95% CI: 7.0-12.1). Late moderate-to-severe TR rate after discharge was 1.9%/year (95% CI: 1.0-3.5). Late reintervention rate was 0.3%/year (95% CI: 0.2-0.4). Mortality and overall (early and late) TR rate were comparable between suture vs. ring annuloplasty (14 studies), whereas overall TR rate was higher after flexible ring vs. rigid ring annuloplasty (6 studies) (7.5%/year vs. 3.9%/year, P = 0.002).
This study shows that patients undergoing surgery for functional tricuspid regurgitation (FTR) have an acceptable early and late mortality. However, TR remains prevalent after surgery. The results of this study can be used to inform patients and clinicians about the expected outcome after surgery for FTR and can results serve as a benchmark for the performance of emerging transcatheter TV interventions.
本研究旨在提供功能性三尖瓣反流（TR）患者行三尖瓣（TV）手术后的当代结局概述。
系统检索了 2005 年 1 月至 2017 年 12 月期间发表的报告功能性 TR 患者行 TV 手术后临床/超声心动图结局的文献。对结局变量进行了随机效应荟萃分析，并通过汇总 Kaplan-Meier 曲线显示晚期结局。对进行了研究内缝线与环修复比较以及柔性与刚性环修复比较的研究进行了亚组分析。共纳入 87 项研究，共 13184 例患者（平均年龄：62.1±11.8 岁，55%为女性）。92%的患者同时行二尖瓣手术。平均随访时间为 4.0±2.8 年。汇总早期死亡率为 3.9%（95%CI：3.2-4.6），晚期死亡率为 2.7%/年（95%CI：2.0-3.5），其中约一半为心源性死亡（1.2%/年，95%CI：0.8-1.9）。汇总出院时早期中重度 TR 风险为 9.4%（95%CI：7.0-12.1）。出院后晚期中重度 TR 发生率为 1.9%/年（95%CI：1.0-3.5）。晚期再介入率为 0.3%/年（95%CI：0.2-0.4）。缝线与环成形术（14 项研究）的死亡率和整体（早期和晚期）TR 发生率相当，而柔性环与刚性环成形术的整体 TR 发生率更高（6 项研究）（7.5%/年比 3.9%/年，P=0.002）。
本研究表明，行功能性三尖瓣反流（FTR）手术的患者早期和晚期死亡率可接受，但术后 TR 仍很常见。本研究结果可用于向患者和临床医生提供关于 FTR 术后预期结果的信息，并可作为新兴经导管 TV 干预措施的基准。
