Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2021 Apr;111(4):1252-1257. doi: 10.1016/j.athoracsur.2020.06.106. Epub 2020 Sep 5.
This study sought to determine the outcome effect of concomitant tricuspid valve operation for regurgitation during pericardiectomy for constrictive pericarditis.
This cohort study included 310 patients with mild or greater tricuspid valve regurgitation who underwent pericardiectomy for constrictive pericarditis from 2000 to 2016 at the Mayo Clinic in Rochester, Minnesota. Patients were divided into 2 treatment groups: tricuspid valve operation (n = 68) and no tricuspid operation (n = 242). Survival analysis, proportional odds models, and landmark analysis were carried out to estimate the treatment effects of tricuspid valve operation.
Tricuspid valve regurgitation was graded mild in 203 (65%) patients, moderate in 69 (22%), and severe in 38 (12%). Tricuspid valve operation included repair in 54 patients (17%) and replacement in 14 (5%). Mechanical circulatory support was used more commonly in the intervention group (15% vs 5%; P = .009), but rates of stroke (3% vs 2%; P = .210) and mortality (9% vs 6%; P = .422) were similar. Tricuspid valve intervention resulted in a reduced risk of long-term mortality (hazard ratio, 0.68; 95% confidence interval [CI], 0.38 to 1.21; P = .192), less than moderate tricuspid valve regurgitation at follow-up (odds ratio vs moderate or severe, 0.093; 95% CI, 0.04 to 0.19), and less than moderate right ventricular enlargement at follow-up (odds ratio vs moderate or severe, 0.67; 95% CI, 0.35 to 1.24). Remnant severe right ventricular dysfunction resulted in increased risk of mortality (hazard ratio vs none or trivial, 4.87; 95% CI, 1.10 to 21.65; P = .037).
Concomitant tricuspid valve operation for regurgitation can be performed without increased operative mortality during pericardiectomy for constrictive pericarditis. Operation appears protective against long-term mortality, residual tricuspid regurgitation, and right ventricular enlargement.
本研究旨在探讨心脏松解术同期行三尖瓣修复或置换术治疗缩窄性心包炎伴反流的效果。
本队列研究纳入了 2000 年至 2016 年在明尼苏达州罗切斯特市梅奥诊所接受心脏松解术治疗缩窄性心包炎的 310 例存在轻度或以上三尖瓣反流的患者。患者被分为两组：三尖瓣手术组（n=68）和非三尖瓣手术组（n=242）。采用生存分析、比例优势模型和 landmark 分析来评估三尖瓣手术的治疗效果。
203 例（65%）患者的三尖瓣反流程度为轻度，69 例（22%）为中度，38 例（12%）为重度。三尖瓣手术包括修复术 54 例（17%）和置换术 14 例（5%）。干预组更常使用机械循环支持（15% vs 5%；P=0.009），但卒中发生率（3% vs 2%；P=0.210）和死亡率（9% vs 6%；P=0.422）相似。三尖瓣干预可降低长期死亡率（风险比，0.68；95%置信区间[CI]，0.38 至 1.21；P=0.192）、随访时中重度三尖瓣反流的发生率（与中重度比较，比值比 0.093；95%CI，0.04 至 0.19）以及随访时中重度右心室扩大的发生率（与中重度比较，比值比 0.67；95%CI，0.35 至 1.24）。残余严重右心室功能障碍会增加死亡率（与无或轻度比较，风险比 4.87；95%CI，1.10 至 21.65；P=0.037）。
心脏松解术同期行三尖瓣反流修复或置换术并不会增加手术死亡率。该术式似乎可预防长期死亡率、残余三尖瓣反流和右心室扩大。
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