Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Ann Thorac Surg. 2020 Nov;110(5):1564-1571. doi: 10.1016/j.athoracsur.2020.02.040. Epub 2020 Mar 26.
This study was conducted to compare long-term clinical outcomes of mechanical and bioprosthetic tricuspid valve replacement (TVR).
Two-hundred twenty-six TVR patients were enrolled; 120 patients underwent bioprosthetic TVR (BTV group) and 106 underwent mechanical TVR (MTV group). Early results and long-term clinical outcomes were compared. The median follow-up duration was 99 months (range, 1-295). Propensity score (PS) analyses including PS-adjusted Cox regression models and 1:1 PS matching were performed.
Mean ages of the MTV and BTV groups were 50.5 ± 10.3 and 60.8 ± 12.0 years, respectively. There were no significant differences in early mortality (4.9% in total) and postoperative complications between the 2 groups. The overall survival and freedom from cardiac death in the MTV group were similar to those in the BTV group (reference, BTV group; hazard ratio [HR], 0.82 [95% confidence interval {CI}, 0.44-1.53] and 0.91 [95% CI, 0.44-1.87], respectively). The risk of a composite of thromboembolism and bleeding was significantly higher in the MTV group (HR, 2.35; 95% CI, 1.16-4.77; P = .018). However the tricuspid valve reoperation rate was significantly lower in the MTV group (HR, 0.11; 95% CI, 0.02-0.53; P = .007). Overall TV-related event rates in the MTV group were similar to those in the BTV group (HR, 0.79; 95% CI, 0.49-1.28). PS matching extracted 69 pairs. Comparative analyses of early- and long-term outcomes from the matched groups yielded similar findings to those from the entire patient groups.
The outcomes of bioprosthetic TVR were comparable with those of mechanical TVR in terms of long-term survival and tricuspid valve-related events over a 15-year postoperative follow-up.
本研究旨在比较机械和生物瓣三尖瓣置换术（TVR）的长期临床结果。
共纳入 226 例 TVR 患者；120 例接受生物瓣 TVR（BTV 组），106 例接受机械瓣 TVR（MTV 组）。比较早期结果和长期临床结果。中位随访时间为 99 个月（范围 1-295）。进行倾向评分（PS）分析，包括 PS 调整的 Cox 回归模型和 1:1 PS 匹配。
MTV 组和 BTV 组的平均年龄分别为 50.5 ± 10.3 岁和 60.8 ± 12.0 岁。两组间早期死亡率（总死亡率为 4.9%）和术后并发症无显著差异。MTV 组的总生存率和无心脏死亡生存率与 BTV 组相似（参考 BTV 组；风险比 [HR]，0.82 [95%置信区间 {CI}，0.44-1.53] 和 0.91 [95% CI，0.44-1.87]）。MTV 组血栓栓塞和出血的复合风险明显更高（HR，2.35；95% CI，1.16-4.77；P =.018）。然而，MTV 组三尖瓣再次手术率明显较低（HR，0.11；95% CI，0.02-0.53；P =.007）。MTV 组的总 TV 相关事件发生率与 BTV 组相似（HR，0.79；95% CI，0.49-1.28）。PS 匹配提取了 69 对。对匹配组的早期和长期结果进行比较分析，得出的结果与整个患者组相似。
在 15 年的术后随访中，生物瓣 TVR 的长期生存和三尖瓣相关事件结果与机械瓣 TVR 相当。
