Department of Cardiothoracic Surgery, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing, China.
Department of Cardiothoracic Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China.
Heart Surg Forum. 2020 Sep 14;23(5):E658-E664. doi: 10.1532/hsf.2981.
Functional tricuspid regurgitation (TR) usually occurs with previous cardiovascular surgery, which causes right-side heart failure and affects patient prognosis. Thus, we aimed to assess the risk and outcomes of isolated tricuspid valve replacement (TVR) after cardiovascular surgery.
We reviewed our hospital medical records and found 107 patients, who had undergone TVR following cardiovascular surgery from June 2009 to November 2017. Follow up was performed by telephone calls, with a mean follow up of 51 months (one to 120 months). Previous surgical procedures of all patients were recorded, and we compared the differences in baseline and preoperative characteristics between the survival and non-survival groups by univariate analysis. Furthermore, logistic regression analysis was performed to identify the risk factors. The variables with a P value < .05 on univariate analysis were entered into a multivariate analysis using stepwise selection.
TVR was performed in 107 patients, including 89 survivors and 18 non-survivors during the follow up. There were 38 male and 69 female patients, and the mean age was 53.55 years. Hospital mortality was 16.8% (18/107). The APACHE II (P < .001) and mechanical ventilation time (P = .001) were higher in the non-survival group. The values of B-type natriuretic peptide (BNP), total bilirubin (TB), and blood urea nitrogen (BUN) before and after the operation and some preoperative values were different between the two groups (P < .05). The logistic regression analysis showed that APACHE II score, mechanical ventilation time, preoperative albumin, and postoperative TB were risk factors for TVR after cardiovascular surgery.
Reoperation tricuspid valve replacement is associated with high operative mortality. High APACHE II scores, mechanical ventilation time and postoperative TB were associated with increased short-term mortality risk, while high preoperative albumin levels decreased the risk. Positive reoperation for tricuspid valve prosthesis dysfunction can obtain satisfactory therapeutic effects, and survivors could benefit from the surgery.
功能性三尖瓣反流（TR）通常发生在心血管手术后，导致右侧心力衰竭并影响患者预后。因此，我们旨在评估心血管手术后单纯行三尖瓣置换术（TVR）的风险和结果。
我们回顾了我院病历，发现 2009 年 6 月至 2017 年 11 月期间有 107 例患者在心血管手术后接受了 TVR。通过电话进行随访，平均随访时间为 51 个月（1 至 120 个月）。记录所有患者的既往手术程序，并通过单因素分析比较生存组和非生存组之间的基线和术前特征差异。此外，还进行了逻辑回归分析以确定危险因素。单因素分析中 P 值<.05 的变量被纳入逐步选择的多因素分析。
107 例患者接受了 TVR，随访期间 89 例存活，18 例死亡。男性 38 例，女性 69 例，平均年龄为 53.55 岁。院内死亡率为 16.8%（18/107）。非生存组的急性生理与慢性健康评分 II（APACHE II）（P<.001）和机械通气时间（P=.001）更高。两组术前和术后的脑钠肽（BNP）、总胆红素（TB）和血尿素氮（BUN）值以及一些术前值均存在差异（P<.05）。逻辑回归分析显示，APACHE II 评分、机械通气时间、术前白蛋白和术后 TB 是心血管手术后 TVR 的危险因素。
再次行三尖瓣置换术与较高的手术死亡率相关。APACHE II 评分高、机械通气时间长和术后 TB 与短期死亡率增加相关，而术前白蛋白水平高则降低了风险。积极对三尖瓣瓣叶功能障碍进行再次手术可以获得满意的治疗效果，且生存者可从中获益。
