Department of Cardiac Surgery, Medical University of Vienna, Vienna, Austria; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre, Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.
Ann Thorac Surg. 2022 Feb;113(2):585-592. doi: 10.1016/j.athoracsur.2021.03.070. Epub 2021 Apr 5.
Isolated tricuspid valve (TV) surgery is a rare procedure generally considered at high risk for perioperative mortality and poor long-term outcomes. Surgical treatment can be performed with either an arrested heart (AH) or beating heart (BH) technique. The aim of this study was to compare the outcomes of isolated tricuspid surgery with 2 different approaches.
The Surgical-Tricuspid Study is a multicenter international retrospective study enrolling adult patients who underwent isolated TV procedures (n = 406; age 56 ± 16 years; 56% female) at 13 international sites. The AH and BH strategies were performed in 253 and 153 patients, respectively. Propensity score-matched analysis was used to compare groups.
After matching, 129 pairs were obtained and analyzed. The 30-day mortality rate was 6.2% versus 5.0% in the AH and BH groups, respectively (P = .9). The rates of acute renal failure requiring replacement therapy (10% versus 3%; P = .02) and stroke (1.6% versus 0%; P = .08) were numerically higher in the AH group. The 6-year survival rate was 67% ± 6% versus 78% ± 5% in the AH and BH groups, respectively (P = .18), whereas freedom from cardiac death was 75% ± 5% versus 84% ± 4% (P = .21). The 6-year composite cardiac end point of cardiac death and reoperation rate was 60% ± 9% versus 86% ± 5% (P = .024) comparing AH-TV replacement and BH-TV repair groups.
Isolated TV surgery performed with a BH strategy is a safe option and resulted in a trend of increased long-term survival and freedom from reoperation compared with the standard AH technique. Patients undergoing BH valve repair had the best long-term outcome.
孤立性三尖瓣手术是一种罕见的手术，通常被认为围手术期死亡率高，长期预后差。手术治疗可以采用心脏停跳（AH）或跳动心脏（BH）技术进行。本研究旨在比较两种不同方法治疗孤立性三尖瓣疾病的结果。
外科三尖瓣研究是一项多中心国际回顾性研究，纳入了在 13 个国际中心接受孤立性三尖瓣手术（n=406；年龄 56±16 岁；56%为女性）的成年患者。AH 和 BH 策略分别在 253 例和 153 例患者中进行。采用倾向评分匹配分析比较两组。
匹配后，获得并分析了 129 对。30 天死亡率分别为 AH 组 6.2%和 BH 组 5.0%（P=0.9）。AH 组急性肾功能衰竭需要替代治疗的发生率（10%比 3%；P=0.02）和中风（1.6%比 0%；P=0.08）较高。AH 组和 BH 组 6 年生存率分别为 67%±6%和 78%±5%（P=0.18），而无心脏死亡生存率分别为 75%±5%和 84%±4%（P=0.21）。与 AH-TV 置换组相比，BH-TV 修复组 6 年复合心脏终点（心脏死亡和再次手术率）为 60%±9%和 86%±5%（P=0.024）。
采用 BH 策略进行孤立性三尖瓣手术是一种安全的选择，与标准的 AH 技术相比，长期生存率和免于再次手术的趋势增加。接受 BH 瓣膜修复的患者具有最佳的长期预后。
