Cardiothoracic Department, Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Cardiology Department, Heart and Lung Centre, Royal Wolverhampton NHS Trust, Wolverhampton, UK.
Heart Surg Forum. 2021 Mar 8;24(2):E261-E266. doi: 10.1532/hsf.3599.
Tricuspid annuloplasty is the most common surgical approach to correct tricuspid regurgitation (TR). In some patients, however, anterior leaflet patch augmentation may be necessary to optimize tricuspid competence. We reviewed our center cohort over the midterm and long term.
From January 2013 to August 2018, 424 tricuspid valve procedures were performed, of which 420 were repairs and 4 were replacements. Indications were either isolated severe TR or moderate or greater TR, concomitant with other surgery. In the repair cohort, we identified those that had a patch augmentation, and the database was interrogated for preoperative characteristics. The resulting patients had outpatient assessment (clinical and echocardiography) at 6 weeks and at a later interval. Additionally, a comparison was made between those who had good and poor results (moderate or greater TR or cardiac death).
In the repair cohort, 19 patients underwent complex tricuspid valve repair with CorMatrix anterior leaflet augmentation. Preoperative characteristics were as follows: age, 65.5 ± 13.5 years; New York Heart Association (NYHA) class, 3.5 ± 0.5; left ventricular ejection fraction, 48.3% ± 5.9%; tricuspid annular plane systolic excursion, 17.1 ± 3.7 mm; right ventricle (good, mild, moderate, poor), 10, 5, 4, 0; annulus size, 40.9 ± 6.9 mm; mean tethering distance, 1.00 ± 0.3 cm; and mean tethering area, 1.53 ± 1.16 cm2. Mean follow-up was 2.1 ± 1.9 years, and survival at 2 years was 73.8%. There were 2 in-hospital deaths. Mean NYHA class was 1.0 ± 0.5 (6 weeks) and 1.5 ± 0.6 (later follow-up); mean residual TR grade was 0.5 ± 0.6 (6 weeks) and 1.3 ± 1.4 (follow-up). Ten of 13 survivors had a good result at last follow-up (TR 0 to 1). We compared the preoperative and operative data of this group versus those with poor results (TR >1 or cardiac mortality). Significant univariate predictors of poor results were larger preoperative tethering area (1.18 ± 0.43 versus 2.4 ± 1.5 cm2; P = .02), longer tethering distance (0.87 ± 0.21 versus 1.2 ± 0.19 cm; P = .007), or the presence of mild or greater TR at 6 weeks (0.2 ± 0.4 vs 1.25 ± 0.5; P = .03).
CorMatrix anterior leaflet augmentation produces successful, stable repair in the majority of this complex population. The presence of even mild TR at 6 weeks' follow-up predicts a poor result. When the tethering area or the tethering distance is significantly high, replacement is probably a better option.
三尖瓣环成形术是纠正三尖瓣反流（TR）最常见的手术方法。然而，在某些患者中，可能需要前瓣叶补片增强以优化三尖瓣功能。我们回顾了我们中心的中期和长期队列。
从 2013 年 1 月至 2018 年 8 月，共进行了 424 例三尖瓣瓣膜手术，其中 420 例为修复术，4 例为置换术。适应证为孤立性严重 TR 或中度或更严重 TR，同时伴有其他手术。在修复组中，我们确定了那些进行了补片增强的患者，并对数据库进行了术前特征的查询。这些患者在术后 6 周和之后的间隔进行门诊评估（临床和超声心动图）。此外，还比较了结果良好和结果不佳（中度或更严重 TR 或心脏死亡）的患者之间的差异。
在修复组中，19 例患者接受了 CorMatrix 前瓣叶增强的复杂三尖瓣瓣修复术。术前特征如下：年龄 65.5 ± 13.5 岁；纽约心脏协会（NYHA）分级 3.5 ± 0.5；左心室射血分数 48.3% ± 5.9%；三尖瓣环平面收缩期位移 17.1 ± 3.7mm；右心室（良好、轻度、中度、差）10、5、4、0；瓣环大小 40.9 ± 6.9mm；平均牵拉力距离 1.00 ± 0.3cm；平均牵拉力面积 1.53 ± 1.16cm2。平均随访时间为 2.1 ± 1.9 年，2 年生存率为 73.8%。有 2 例院内死亡。平均 NYHA 分级为 1.0 ± 0.5（6 周）和 1.5 ± 0.6（随访后期）；平均残余 TR 分级为 0.5 ± 0.6（6 周）和 1.3 ± 1.4（随访）。13 例幸存者中有 10 例在最后一次随访时结果良好（TR0 至 1）。我们比较了这组患者与结果不佳（TR>1 或心脏死亡）患者的术前和手术数据。结果不佳的显著单因素预测因子包括较大的术前牵拉力面积（1.18 ± 0.43 比 2.4 ± 1.5cm2；P =.02）、较长的牵拉力距离（0.87 ± 0.21 比 1.2 ± 0.19cm；P =.007）或 6 周时存在轻度或更严重的 TR（0.2 ± 0.4 比 1.25 ± 0.5；P =.03）。
CorMatrix 前瓣叶增强在大多数复杂患者中产生了成功、稳定的修复效果。即使在 6 周随访时存在轻度 TR，也预示着结果不佳。当牵拉力面积或牵拉力距离明显较高时，置换可能是更好的选择。
