行冠状动脉旁路移植术患者三尖瓣反流的负担。
Burden of Tricuspid Regurgitation in Patients Undergoing Coronary Artery Bypass Grafting.
机构信息
Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia.
INOVA Heart and Vascular Institute, Falls Church, Virginia.
出版信息
Ann Thorac Surg. 2021 Jan;111(1):44-50. doi: 10.1016/j.athoracsur.2020.04.038. Epub 2020 Jun 1.
BACKGROUND
Tricuspid regurgitation (TR) is associated with poor outcomes after cardiac surgery. Guidelines recommend correction of severe TR in patients undergoing left-sided valve surgery but not coronary artery bypass graft surgery (CABG). We sought to evaluate impact of TR on outcomes after CABG.
METHODS
All patients (n = 28,027) undergoing CABG in The Society of Thoracic Surgeons (STS) regional database (2011 to 2018) were stratified by TR severity. Primary outcomes included major morbidity or mortality, which were compared using univariate analysis.
RESULTS
Of patients undergoing CABG, 4837 (17%) had mild, 800 (3%) had moderate, and 81 (0.29%) had severe TR. Increased severity was associated with higher rate of preoperative heart failure (none 5162 [23.4%] vs mild 1697 [35%] vs moderate 427 [53%] vs severe 54 [67%], P < .001] and STS predicted risk of mortality (1.0 [0.6 to 1.9) vs 1.4 [0.8 to 2.9] vs 2.8 [1.4 to 5.4] vs 6.2 [2.2 to 11.4], P < .001). Increasing severity was associated with higher postoperative rate of renal failure (426 [1.9%] vs 145 [3%] vs 58 [7.3%] vs 7 [8.6%], P < .001), prolonged ventilation (1652 [7.5%] vs 495 [10.2%] vs 153 [19.1%] vs 22 [27.2%], P < .001), and mortality (344 [1.6%] vs 132 [2.7%] vs 58 [7.3%] vs 9 [11.1%], P < .001). After risk adjustment, mild, moderate, and severe TR remained associated with increased morbidity and mortality (all P < .05).
CONCLUSIONS
Increasing TR severity, although independently associated with higher surgical risk, is not accounted for entirely by STS risk calculator. This highlights the importance of TR on operative risk and supports consideration of concurrent tricuspid intervention for patients with significant TR undergoing CABG.
背景
三尖瓣反流（TR）与心脏手术后的不良预后相关。指南建议在接受左侧瓣膜手术的患者中纠正严重的 TR，但不建议在接受冠状动脉旁路移植术（CABG）的患者中纠正。我们旨在评估 TR 对 CABG 后结局的影响。
方法
在胸外科医师学会（STS）区域数据库（2011 年至 2018 年）中接受 CABG 的所有患者（n=28027）按 TR 严重程度分层。主要结局包括主要发病率或死亡率，使用单变量分析进行比较。
结果
在接受 CABG 的患者中，4837 例（17%）为轻度、800 例（3%）为中度、81 例（0.29%）为重度 TR。严重程度增加与术前心力衰竭发生率较高相关（无心力衰竭 5162 例[23.4%]、轻度心力衰竭 1697 例[35%]、中度心力衰竭 427 例[53%]、重度心力衰竭 54 例[67%]，P<0.001）和 STS 预测死亡率风险（1.0[0.6 至 1.9]、1.4[0.8 至 2.9]、2.8[1.4 至 5.4]、6.2[2.2 至 11.4]，P<0.001）。严重程度增加与术后肾衰竭发生率较高相关（426 例[1.9%]、145 例[3%]、58 例[7.3%]、7 例[8.6%]，P<0.001）、通气时间延长（1652 例[7.5%]、495 例[10.2%]、153 例[19.1%]、22 例[27.2%]，P<0.001）和死亡率（344 例[1.6%]、132 例[2.7%]、58 例[7.3%]、9 例[11.1%]，P<0.001）。在风险调整后，轻度、中度和重度 TR 仍然与发病率和死亡率增加相关（均 P<0.05）。
结论
尽管 TR 严重程度独立与较高的手术风险相关，但不完全由 STS 风险计算器解释。这凸显了 TR 对手术风险的重要性，并支持对接受 CABG 的严重 TR 患者进行同期三尖瓣干预的考虑。
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