Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel.
Department of Cardiac Surgery, Rambam Health Care Campus and Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
Ann Thorac Surg. 2022 Mar;113(3):793-799. doi: 10.1016/j.athoracsur.2021.03.104. Epub 2021 Apr 25.
Isolated tricuspid valve replacement (TVR) is considered high-risk surgery. We investigated our outcomes of TVR with the aim of identifying variables that may influence morbidity and mortality of isolated TVR compared with combined TVR and left-sided valve surgery.
Retrospective analysis of patients undergoing TVR surgery. The primary endpoint was long-term mortality. The association of postoperative outcomes with isolated compared with combined replacement was analyzed. The association between type of surgery and mortality over time was evaluated using Cox proportional hazards regression models to estimate the hazard ratio.
Overall, 70 patients underwent TVR. Mean age was 61 ± 12 years and 74% (52 of 70) were women. About two thirds (61%) of the study population had a diagnosis of rheumatic heart disease and 8% (6 of 70) had previous infectious endocarditis. Atrial fibrillation was prevalent (86%, 60 of 70). Comorbidities were similar between groups. Tricuspid valve replacement combined with left-sided valvular surgery was performed in 37 patients (53%), and isolated replacement in 33 patients (47%). Previous cardiac surgery was common (40 patients, 57%). One-month survival rate was 94.3% (66 of 70). During a median follow-up period of 3.6 years, 12 patients (17%) died. The cumulative 5-year survival tended to be lower among patients with isolated TVR compared with patients having combined surgery.
We showed that TVR can be performed with good outcomes. Isolated TVR did not increase morbidity and mortality when patients are referred for surgery early, including after previous sternotomy. This finding should perhaps lead to a more aggressive approach toward patients requiring isolated replacement.
孤立性三尖瓣置换术（TVR）被认为是高风险手术。我们研究了 TVR 的结果，旨在确定可能影响孤立性 TVR 发病率和死亡率的变量，与 TVR 联合左侧瓣膜手术相比。
回顾性分析接受 TVR 手术的患者。主要终点是长期死亡率。分析术后结果与孤立性置换与联合置换的关系。使用 Cox 比例风险回归模型评估手术类型与死亡率随时间的关系，以估计风险比。
共有 70 例患者接受了 TVR。平均年龄为 61 ± 12 岁，74%（52/70）为女性。约三分之二（61%）的研究人群患有风湿性心脏病，8%（6/70）有既往感染性心内膜炎。房颤患病率高（86%，60/70）。两组的合并症相似。37 例（53%）患者行 TVR 联合左侧瓣膜手术，33 例（47%）患者行孤立性置换。既往心脏手术常见（40 例，57%）。1 个月生存率为 94.3%（66/70）。中位随访 3.6 年后，12 例（17%）患者死亡。孤立性 TVR 患者的 5 年累积生存率似乎低于联合手术患者。
我们表明 TVR 可以获得良好的结果。当患者早期接受手术，包括在先前开胸手术后，孤立性 TVR 并不会增加发病率和死亡率。这一发现可能会导致对需要孤立性置换的患者采取更积极的治疗方法。
