Pfannmueller Bettina, Misfeld Martin, Davierwala Piroze, Weiss Stefan, Borger Michael Andrew
Department of Heart Surgery, Leipzig Heart Centre, Leipzig University Hospital, Leipzig, Germany.
Leipzig Heart Institute GmbH, Leipzig, Germany.
Thorac Cardiovasc Surg. 2020 Sep;68(6):486-491. doi: 10.1055/s-0039-1700506. Epub 2019 Dec 31.
Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery.
We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without ( = 3,463; MVr group) and with ( = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed.
Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr ( < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort.
Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.
由于手术时间延长且手术风险可能增加，三尖瓣（TV）手术与微创二尖瓣（MV）修复术同期进行存在争议。在此，我们研究了接受MV修复术且同期行或不行TV手术患者的体外循环时间和30天死亡率。
我们回顾性评估了1999年至2014年间3962例MV反流患者，这些患者接受了微创MV修复术，其中未同期行TV手术的有3463例（MVr组），同期行TV手术的有499例（MVr + TVr组）。两组术前参数存在显著差异；因此，进行了倾向得分匹配。
MVr组所有患者的平均体外循环时间为125.5±55.8分钟，MVr + TVr组为162.0±58.0分钟（P < 0.001）。两组的总体30天死亡率存在显著差异（4.8%对2.1%；P < 0.001）；然而，调整后无显著差异（3.3%对1.2%；P = 0.07）。向后逻辑回归显示，体外循环时间不是MVr + TVr队列早期死亡率的显著预测因素。
通过微创方法使用人工瓣环同期进行TV修复是安全的，在我们的患者队列中不会导致早期死亡率升高。因此，体外循环时间延长不应成为排除MV修复术同期进行TV修复术以及更倾向使用缝合技术的唯一理由，与人工瓣环植入相比，缝合技术仅节省几分钟时间。
