Department of Thoracic and Cardiovascular Surgery, Sejong General Hospital, Bucheon, Gyeonggi-do, Republic of Korea.
Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Republic of Korea.
Ann Thorac Surg. 2021 Sep;112(3):803-808. doi: 10.1016/j.athoracsur.2020.09.028. Epub 2020 Nov 4.
The edge-to-edge technique (Alfieri stitch) has been widely adopted in mitral valve but not tricuspid valve (TV) repair. We evaluated long-term clinical and hemodynamic outcomes of tricuspid edge-to-edge repair.
We retrospectively reviewed 237 patients (mean age, 58.4 ± 13.9 years) who had undergone tricuspid edge-to-edge repair from January 2001 to March 2019 in our institution. Tricuspid annuloplasty was performed in 175 patients (73.8%) using ring (91 [38.4%]) or suture (84 [35.4%]) annuloplasty. Concomitant procedures were mitral valve replacement (133 [56.1%]), mitral valve repair (52 [21.9%]), aortic valve replacement (41 [17.3%]), and maze operation (138 [58.2%]).
Postoperative echocardiography revealed mild or less tricuspid regurgitation (TR) in 220 patients (92.8%). Early mortality (<30 days) occurred in 9 patients (3.8%), reoperation for bleeding in 16 (6.8%), and low cardiac output syndrome in 15 (6.4%). Freedom from all-cause mortality was 87.2% at 5 years and 80.6% at 10 years. Freedom from moderate or severe TR was 97.1% at 5 years and 84.9% at 10 years. Transtricuspid pressure gradient was 3.8 ± 4.2 mm Hg at discharge and 3.2 ± 5.6 mm Hg at the last follow-up (P = .60). Freedom from significant tricuspid stenosis (transtricuspid pressure gradient ≥5 mm Hg) was 96.4% and 88.4% at 5 and 10 years, respectively. There was 1 early TV reoperation for severe TR on postoperative day 3 (0.4%). Freedom from TV reoperation was 99.1% at 10 years.
Tricuspid edge-to-edge repair showed acceptable long-term clinical and hemodynamic results and is an effective and safe option in TV surgery.
边缘对边缘技术（Alfieri 缝合术）已广泛应用于二尖瓣修复，但尚未应用于三尖瓣（TV）修复。我们评估了三尖瓣边缘对边缘修复的长期临床和血流动力学结果。
我们回顾性分析了 2001 年 1 月至 2019 年 3 月期间在我院接受三尖瓣边缘对边缘修复的 237 例患者（平均年龄 58.4±13.9 岁）。175 例患者（73.8%）接受三尖瓣环成形术，其中 91 例（38.4%）采用环（91[38.4%]）或缝线（84[35.4%]）环成形术。同期行二尖瓣置换术（133 例[56.1%]）、二尖瓣修复术（52 例[21.9%]）、主动脉瓣置换术（41 例[17.3%]）和迷宫手术（138 例[58.2%]）。
术后超声心动图显示 220 例（92.8%）患者存在轻度或轻度以下三尖瓣反流（TR）。9 例（3.8%）患者术后 30 天内死亡，16 例（6.8%）患者因出血行再次手术，15 例（6.4%）患者发生低心排综合征。5 年和 10 年时全因死亡率分别为 87.2%和 80.6%。5 年和 10 年时中重度 TR 无复发生存率分别为 97.1%和 84.9%。出院时跨三尖瓣压差为 3.8±4.2mmHg，末次随访时为 3.2±5.6mmHg（P=0.60）。5 年和 10 年时，跨三尖瓣压差≥5mmHg 的显著三尖瓣狭窄无复发生存率分别为 96.4%和 88.4%。术后第 3 天（0.4%）行早期 TV 再次手术治疗重度 TR。10 年时 TV 再次手术无复发生存率为 99.1%。
三尖瓣边缘对边缘修复术具有良好的长期临床和血流动力学效果，是一种有效且安全的 TV 手术选择。
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