Flagiello Michele, Grinberg Daniel, Connock Martin, Armoiry Xavier, Buzzi Remi, Thibault Helene, Uhlrich William, Jacquet-Lagreze Matthias, Fellahi Jean L, Obadia Jean F, Pozzi Matteo
Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France.
Division of Health Sciences, University of Warwick Medical School, Coventry, UK.
J Card Surg. 2021 Mar;36(3):1020-1027. doi: 10.1111/jocs.15390. Epub 2021 Feb 1.
Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique.
We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross-clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity-score matching.
From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In-hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36-10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36-9.97). Age was the only predictor of in-hospital mortality.
The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.
与心脏停搏（AH）技术相比，关于心脏跳动（BH）技术用于单纯三尖瓣（TV）手术的数据较少。我们比较了BH技术与AH技术在单纯TV手术中的效果。
我们对单纯TV手术数据库进行了观察性分析。根据手术时是否进行主动脉交叉钳夹和心脏停搏（BH组未进行，AH组进行）将患者分为两组。主要终点是出院生存率。通过多因素分析寻找院内死亡的危险因素。在倾向评分匹配后进行进一步比较。
2007年1月至2017年12月，我们进行了82例单纯TV手术（BH组，n = 47，57.3%；AH组，n = 35，42.7%）。平均年龄为59.1岁，56.1%为女性。BH组患者年龄更大（61.8岁对55.4岁；p = 0.035），肾功能损害更严重（肾小球滤过率，61.1对74.6 ml/分钟；p = 0.012），因继发性三尖瓣反流进行手术的频率更高（61.7%对31.4%；p = 0.008），再次手术的频率更高（53.2%对28.6%；p = 0.042），且手术风险更高（欧洲心脏手术风险评估系统II，3.92对2.50%；p = 0.013）。两组的院内死亡率无差异，无论是未匹配人群（BH = 10.6%对AH = 5.7%；OR = 1.96，95%置信区间[CI] = 0.36 - 10.77）还是匹配人群（BH = 10.6%对AH = 6.4%；OR = 1.89，95% CI = 0.36 - 9.97）。年龄是院内死亡的唯一预测因素。
尽管风险特征较高，但对于单纯TV手术，BH技术与AH技术的效果相当。
