Yu Peng-Ming, Wang Yu-Qiang, Luo Ze-Ruxing, Tsang Raymond C C, Tronstad Oystein, Shi Jun, Guo Ying-Qiang, Jones Alice Y M
Rehabilitation Medicine Center, Sichuan University West China Hospital, Chengdu, China.
Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, China.
Front Cardiovasc Med. 2022 May 19;9:904961. doi: 10.3389/fcvm.2022.904961. eCollection 2022.
To investigate the incidence of postoperative pulmonary complications (PPCs) and short-term recovery after transcatheter tricuspid valve implantation (TTVI).
A total of 17 patients diagnosed with severe tricuspid regurgitation who received a LuX-valve TTVI were included in this study. Spirometry lung function, maximal inspiratory pressure (MIP), and 6-min walk test distance (6MWD) were recorded. Prior to surgery, patients were stratified into high or low pulmonary risk groups based on published predefined criteria. A physiotherapist provided all patients with education on thoracic expansion exercises, effective cough and an inspiratory muscle training protocol at 50% of MIP for 3 days preoperatively. All patients received standard post-operative physiotherapy intervention including positioning, thoracic expansion exercises, secretion removal techniques and mobilization. Patients were assessed for PPCs as defined by the Melbourne-Group Score-version 2. Clinical characteristics and hospital stay, cost, functional capacity, and Kansas City Cardiomyopathy Questionnaire (KCCQ) heart failure score were recorded at admission, 1-week, and 30-days post-op.
The mean () age of the 17 patients was 68.4 (8.0) years and 15 (88%) were female. Pre-surgical assessment identified 8 patients (47%) at high risk of PPCs. A total of 9 patients (53%) developed PPCs between the 1st and 3rd day post-surgery, and 7 of these 9 patients were amongst the 8 predicted as "high risk" prior to surgery. One patient died before the 30 day follow up. Pre-operative pulmonary risk assessment score, diabetes mellitus, a low baseline MIP and 6MWD were associated with a high incidence of PPCs. Compared to those without PPCs, patients with PPCs had longer ICU and hospital stay, and higher hospitalization cost. At 30 days post-surgery, patients without PPCs maintained higher MIP and 6MWD compared to those with PPCs, but there were no significant between-group differences in other lung function parameters nor KCCQ.
This is the first study to report the incidence of PPCs post TTVI. Despite a 3-day prehabilitation protocol and standard post-operative physiotherapy, PPCs were common among patients after TTVI and significantly impacted on hospital and short-term recovery and outcomes. In the majority of patients, PPCs could be accurately predicted before surgery. A comprehensive prehabilitation program should be considered for patients prior to TTVI.
[www.ClinicalTrials.gov], identifier [ChiCTR2000039671].
研究经导管三尖瓣植入术（TTVI）后肺部并发症（PPCs）的发生率及短期恢复情况。
本研究纳入了17例诊断为严重三尖瓣反流并接受LuX瓣膜TTVI的患者。记录肺活量测定肺功能、最大吸气压力（MIP）和6分钟步行试验距离（6MWD）。术前，根据已发表的预定义标准将患者分为高或低肺风险组。一名物理治疗师在术前3天为所有患者提供关于胸廓扩张运动、有效咳嗽和以MIP的50%进行吸气肌训练方案的教育。所有患者均接受标准的术后物理治疗干预，包括体位摆放、胸廓扩张运动、分泌物清除技术和活动。根据墨尔本组评分第2版对患者进行PPCs评估。记录入院时、术后1周和30天时的临床特征、住院时间、费用、功能能力和堪萨斯城心肌病问卷（KCCQ）心力衰竭评分。
17例患者的平均年龄为68.4（8.0）岁，15例（88%）为女性。术前评估确定8例患者（47%）有发生PPCs的高风险。共有9例患者（53%）在术后第1天至第3天发生PPCs，这9例患者中有7例在术前被预测为“高风险”。1例患者在30天随访前死亡。术前肺风险评估评分、糖尿病、较低的基线MIP和6MWD与PPCs的高发生率相关。与未发生PPCs的患者相比，发生PPCs的患者ICU和住院时间更长，住院费用更高。术后30天时，未发生PPCs的患者与发生PPCs的患者相比，MIP和6MWD更高，但两组在其他肺功能参数和KCCQ方面无显著差异。
这是第一项报告TTVI后PPCs发生率的研究。尽管有3天的术前康复方案和标准的术后物理治疗，但PPCs在TTVI后的患者中很常见，并且对住院和短期恢复及结局有显著影响。在大多数患者中，PPCs在手术前可以被准确预测。TTVI术前应考虑为患者制定全面的术前康复计划。
