Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, No.2 Anzhen Road, Chaoyang District, Beijing, 100029, PR China.
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
J Cardiothorac Surg. 2020 Sep 29;15(1):277. doi: 10.1186/s13019-020-01336-3.
This study aimed to describe the mid-term outcomes of different treatments in patients with atrial fibrillation caused tricuspid regurgitation.
A retrospective study of patients diagnosed as atrial fibrillation caused moderate-severe tricuspid regurgitation undergoing ablation (n = 411) were reviewed. The surgical cohort (n = 114) underwent surgical ablation and tricuspid valve repair; the catheter cohort (n = 279) was selected from those patients who had catheter ablation.
The estimated actuarial 5-year survival rates were 96.8% (95% CI: 92.95-97.78) and 92.0% (95% CI: 85.26-95.78) in the catheter and surgical cohort, respectively. Tethering height was showed as independent risk factors for recurrent atrial fibrillation and tricuspid regurgitation in both cohorts. A matched group analysis using propensity-matched was conducted after categorizing total patients by tethering height < 6 mm and ≥ 6 mm. Kaplan-Meier analysis showed in patients with tethering height < 6 mm, there were no differences in survival from mortality, stroke, recurrent atrial fibrillation and tricuspid regurgitation between two groups. In patients with tethering height ≥ 6 mm, there were significantly higher cumulative incidence of stroke (95% CI, 0.047-0.849; P = 0.029), recurrent atrial fibrillation (95% CI, 0.357-09738; P = 0.039) and tricuspid regurgitation (95% CI, 0.359-0.981; P = 0.042) in catheter group.
Atrial fibrillation caused tricuspid regurgitation resulted in less leaflets coaptation, which risk the recurrence of atrial fibrillation and tricuspid regurgitation. Patients whose tethering height was less than 6 mm showed satisfying improvement in tricuspid regurgitation with the restoration of sinus rhythm after catheter ablation. However, in patients with severe leaflets tethering, the results favored surgical over catheter.
本研究旨在描述不同治疗方法在由心房颤动引起的三尖瓣反流患者中的中期结果。
回顾性分析了诊断为中度至重度三尖瓣反流并接受消融治疗的 411 例心房颤动患者。手术组（n=114）行手术消融和三尖瓣修复；导管组（n=279）从接受导管消融的患者中选择。
导管组和手术组的 5 年估计累积生存率分别为 96.8%（95%CI：92.95-97.78）和 92.0%（95%CI：85.26-95.78）。在两组中，连合高度均为复发性心房颤动和三尖瓣反流的独立危险因素。根据连合高度<6mm 和≥6mm 对所有患者进行分类后，采用倾向匹配进行匹配组分析。Kaplan-Meier 分析显示，在连合高度<6mm 的患者中，两组之间的死亡率、中风、复发性心房颤动和三尖瓣反流的生存差异无统计学意义。在连合高度≥6mm 的患者中，导管组的中风（95%CI，0.047-0.849；P=0.029）、复发性心房颤动（95%CI，0.357-09738；P=0.039）和三尖瓣反流（95%CI，0.359-0.981；P=0.042）的累积发生率明显较高。
由心房颤动引起的三尖瓣反流导致瓣叶结合减少，从而增加了心房颤动和三尖瓣反流的复发风险。在导管消融后恢复窦性心律的情况下，连合高度小于 6mm 的患者三尖瓣反流得到了令人满意的改善。然而，在严重瓣叶连合的患者中，手术优于导管。
