Division of Cardiovascular Surgery, Heart and Vascular Institute, Funabashi Municipal Medical Center, 1-21-1 Kanasugi, Chiba, Funabashi, 273-8588, Japan.
Department of Cardiovascular Surgery, Chiba University Hospital, Chiba, Japan.
Gen Thorac Cardiovasc Surg. 2021 Apr;69(4):662-672. doi: 10.1007/s11748-020-01501-4. Epub 2020 Oct 3.
To elucidate the impact of tricuspid annuloplasty concomitant with left-sided valve surgery on the right ventricular (RV) function in patients with mild or more tricuspid regurgitation (TR).
We enrolled 136 patients with mild or more TR who underwent left-sided valve surgery. Seventy-three patients underwent left-sided valve surgery alone (group non-T) and 63 underwent concomitant tricuspid annuloplasty (group T). The echocardiographic data at the latest follow-up (mean 1019 days) were compared using multiple regression analysis to adjust cofounding factors. Propensity score was calculated and included in the analysis as a covariate. In addition, propensity score matching was used for sensitive analysis (12 pairs).
In group non-T, there were more aortic valve surgeries, and fewer mitral valve surgeries. At baseline, body surface area, New York Heart Association class, and prevalence of atrial fibrillation were significantly different between groups. On preoperative echocardiography, left and right atrial diameter, RV diameter, and tricuspid annular diameter were larger in group T, whereas there was no significant difference in RV fractional area change. In multiple regression analyses, RV diameter in diastole was significantly lower and RV fractional area change was significantly higher at the follow-up period in group T. These results were not attenuated even in subgroup analysis in patients with only mild TR or mitral valve surgery alone.
Among patients with mild or more TR, RV dimensional and functional recovery was not obtained with left-sided valve surgery alone. Adding tricuspid annuloplasty may potentially achieve both outcomes.
为了阐明在伴有轻度或更严重三尖瓣反流（TR）的患者中，同期行三尖瓣环成形术对左心瓣膜手术后右心室（RV）功能的影响。
我们纳入了 136 例伴有轻度或更严重 TR 的患者，这些患者均接受了左心瓣膜手术。73 例患者仅接受了左心瓣膜手术（非 T 组），63 例患者同期接受了三尖瓣环成形术（T 组）。使用多元回归分析比较了最新随访（平均 1019 天）的超声心动图数据，以调整混杂因素。计算倾向评分并将其作为协变量纳入分析。此外，还使用倾向评分匹配进行敏感性分析（12 对）。
在非 T 组中，主动脉瓣手术更多，而二尖瓣手术更少。在基线时，体表面积、纽约心脏协会心功能分级和房颤发生率在两组间存在显著差异。在术前超声心动图中，T 组的左、右心房直径、RV 直径和三尖瓣环直径更大，而 RV 射血分数在两组间无显著差异。在多元回归分析中，T 组在随访期间 RV 舒张末期直径更小，RV 射血分数更高。即使在仅伴有轻度 TR 或仅行二尖瓣手术的患者亚组分析中，这些结果也未减弱。
在伴有轻度或更严重 TR 的患者中，单纯行左心瓣膜手术并不能获得 RV 形态和功能的恢复。同期行三尖瓣环成形术可能潜在地实现这两个目标。
