Division of Cardiology Department of Medicine West Virginia University Morgantown WV.
Division of Cardiology Department of Medicine University of Kentucky Lexington KY.
J Am Heart Assoc. 2021 Jan 19;10(2):e018417. doi: 10.1161/JAHA.120.018417. Epub 2021 Jan 5.
Background Whether the poor outcomes of isolated tricuspid valve surgery are related to the operation itself or to certain patient characteristics including late referral is unknown. Methods and Results Adult patients who underwent isolated tricuspid valve surgery were identified in the Nationwide Readmissions Database (2016-2017). Patients who had redo tricuspid valve surgery, endocarditis, or congenital heart disease were excluded. Multivariable logistic regression was performed to identify contributors to postoperative mortality. A total of 1513 patients were included (mean age 55.7±16.6 years, 49.6% women). Surrogates of late referral were frequent: 41% of patients were admitted with decompensated heart failure, 44.3% had a nonelective surgery status, 16.8% had advanced liver disease, and 31% had an unplanned hospitalization in the prior 90 days. The operation was performed on day 0 to 1 of the hospitalization in only 50% of patients, and beyond day 10 in 22% of patients. In-hospital mortality occurred in 8.7% of patients. Median length of stay was 14 days (7-35 days), and median cost was $87 223 ($43 122-$200 872). In multivariable logistic regression analysis, surrogates for late referrals (acute heart failure decompensation, nonelective surgery status, or advanced liver disease) were the strongest predictors of in-hospital mortality (odds ratio [OR], 4.75; 95% CI, 2.74-8.25 [<0.001]). This was also consistent in a second model incorporating unplanned hospitalizations in the 90 days before surgery as a surrogate for late referral (OR, 5.50; 95% CI, 2.28-10.71 [<0.001]). Conclusions The poor outcomes of isolated tricuspid valve surgery may be largely explained by the late referral for intervention. Studies are needed to determine the role of early intervention for severe isolated tricuspid regurgitation.
孤立性三尖瓣手术不良结局是与手术本身相关，还是与某些患者特征（包括晚期转诊）相关，目前尚不清楚。
在全国再入院数据库（2016-2017 年）中确定了接受孤立性三尖瓣手术的成年患者。排除再次三尖瓣手术、心内膜炎或先天性心脏病患者。采用多变量逻辑回归分析确定术后死亡率的影响因素。共纳入 1513 例患者（平均年龄 55.7±16.6 岁，49.6%为女性）。晚期转诊的替代指标很常见：41%的患者因心力衰竭失代偿而入院，44.3%的患者为非择期手术，16.8%的患者有晚期肝病，31%的患者在入院前 90 天内有计划外住院。只有 50%的患者在入院后 0-1 天内接受手术，22%的患者在入院后 10 天以上接受手术。住院期间死亡率为 8.7%。中位住院时间为 14 天（7-35 天），中位费用为 87223 美元（43122-200872 美元）。多变量逻辑回归分析显示，晚期转诊的替代指标（急性心力衰竭失代偿、非择期手术或晚期肝病）是住院死亡率的最强预测因素（比值比 [OR]，4.75；95%置信区间，2.74-8.25[<0.001]）。在第二个模型中，将手术前 90 天内的计划外住院作为晚期转诊的替代指标，结果也一致（OR，5.50；95%置信区间，2.28-10.71[<0.001]）。
孤立性三尖瓣手术不良结局可能主要归因于晚期转诊干预。需要研究早期干预严重孤立性三尖瓣反流的作用。
