Dreyfus Julien, Flagiello Michele, Bazire Baptiste, Eggenspieler Florian, Viau Florence, Riant Elisabeth, Mbaki Yannick, Bohbot Yohann, Eyharts Damien, Senage Thomas, Dubrulle Henri, Nicol Martin, Doguet Fabien, Nguyen Virginia, Coisne Augustin, Le Tourneau Thierry, Lavie-Badie Yoan, Tribouilloy Christophe, Donal Erwan, Tomasi Jacques, Habib Gilbert, Selton-Suty Christine, Raffoul Richard, Iung Bernard, Obadia Jean-François, Messika-Zeitoun David
Cardiology Department, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, Saint-Denis 93200, France.
Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, 59 Boulevard Pinel, 69500 Bron, France.
Eur Heart J. 2020 Dec 1;41(45):4304-4317. doi: 10.1093/eurheartj/ehaa643.
The aim of this study was to identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) and more specifically the impact of tricuspid regurgitation (TR) mechanism and clinical presentation.
Among 5661 consecutive adult patients who underwent a tricuspid valve (TV) surgery at 12 French tertiary centres in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease [47% in New York Heart Association (NYHA) III/IV, 57% with right-sided heart failure (HF) signs]. Tricuspid regurgitation was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31%, respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14% vs. 6%, P = 0.004), but presentation was more severe. Independent determinants of outcomes were NYHA Class III/IV [odd ratios (OR) = 2.7 (1.2-6.1), P = 0.01], moderate/severe right ventricular dysfunction [OR = 2.6 (1.2-5.8), P = 0.02], lower prothrombin time [OR = 0.98 (0.96-0.99), P = 0.008], and with borderline statistical significance, right-sided HF signs [OR = 2.4 (0.9-6.5), P = 0.06] while TR mechanism was not [OR = 0.7 (0.3-1.8), P = 0.88].
Isolated TV surgery was associated with high mortality and morbidity, both in hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.
本研究旨在确定单纯三尖瓣手术（ITVS）后院内及中期结局的决定因素，更具体地说是三尖瓣反流（TR）机制和临床表现的影响。
从一个强制性行政数据库收集的2007 - 2017年在法国12个三级中心接受三尖瓣（TV）手术的5661例连续成年患者中，我们确定了466例接受ITVS的患者（占所有三尖瓣手术的8%）。大多数患者表现为晚期疾病[纽约心脏协会（NYHA）III/IV级占47%，有右侧心力衰竭（HF）体征的占57%]。三尖瓣反流功能性的占49%（既往左侧心脏瓣膜手术者占22%，单纯性的占27%），器质性的占51%（感染性心内膜炎占31%，其他原因占20%）。院内死亡率和主要并发症发生率分别为10%和31%。5年时的生存率和无HF再入院生存率分别为75%和62%。功能性TR患者的院内死亡率高于器质性TR患者（14%对6%，P = 0.004），但临床表现更严重。结局的独立决定因素为NYHA III/IV级[比值比（OR）= 2.7（1.2 - 6.1），P = 0.01]、中度/重度右心室功能障碍[OR = 2.6（1.2 - 5.8），P = 0.02]、较低的凝血酶原时间[OR = 0.98（0.96 - 0.99），P = 0.008]，以及具有临界统计学意义的右侧HF体征[OR = 2.4（0.9 - 6.5），P = 0.06]，而TR机制并非如此[OR = 0.7（0.3 - 1.8），P = 0.88]。
单纯TV手术在院内和随访期间均与高死亡率和高发病率相关，由临床表现的严重程度而非TR机制预测。我们的结果表明，TV干预应在疾病进程中更早进行。
