Division of Cardiology, Department of Internal Medicine, Cardiovascular Imaging Center, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon, Republic of Korea.
ESC Heart Fail. 2022 Dec;9(6):3868-3875. doi: 10.1002/ehf2.14057. Epub 2022 Aug 5.
Tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR) is becoming more common, but the associated mortality remains high. Therefore, we evaluated the clinical and echocardiographic parameters associated with all-cause mortality in patients with severe functional TR who underwent TV surgery.
A total of 286 patients with severe functional TR who underwent TV replacement or repair was analysed between January 2006 and December 2017. We assessed changes in conventional echocardiographic parameters and strain, such as peak atrial longitudinal strain (PALS). During a median follow-up period of 5.3 years, 71 (24.8%) patients died due to any cause. When comparing groups with and without all-cause deaths, there were no significant differences in terms of sex, co-morbidities, medication use, and surgery type. However, patients who died were older and more likely to have refractory atrial fibrillation (AF). With multivariate Cox modelling, age >65 years (adjusted hazard ratio [HR], 2.81, 95% confidence interval [CI], 1.59-4.96; P < 0.001), refractory AF (adjusted HR, 2.84, 95% CI, 1.36-5.94; P = 0.006), lower albumin level (adjusted HR, 0.50, 95% CI, 0.31-0.82), and reduced PALS (adjusted HR, 1.87, 95% CI, 1.06-3.33; P = 0.032) were significant determinants of all-cause mortality. PALS decline was associated with refractory AF (adjusted HR, 5.74, 95% CI, 2.81-11.7; P < 0.001) and the absence of a Maze procedure (adjusted HR, 2.95, 95% CI, 1.51-5.78; P = 0.002).
A reduction in PALS was significantly associated with all-cause mortality in our cohort of patients with severe functional TR who underwent TV surgery. This phenomenon is related to refractory AF and more aggressive intervention for AF is necessary concomitant with TV surgery.
功能性三尖瓣反流（TR）的三尖瓣（TV）手术越来越常见，但相关死亡率仍然很高。因此，我们评估了接受 TV 手术的严重功能性 TR 患者的全因死亡率相关的临床和超声心动图参数。
2006 年 1 月至 2017 年 12 月期间，我们分析了 286 例接受 TV 置换或修复的严重功能性 TR 患者。我们评估了传统超声心动图参数和应变（如峰值心房长轴应变（PALS））的变化。在中位随访 5.3 年期间，71 例（24.8%）患者因任何原因死亡。在比较有和无全因死亡的组之间，在性别、合并症、药物使用和手术类型方面无显著差异。然而，死亡患者年龄更大，更有可能患有难治性心房颤动（AF）。多变量 Cox 模型分析显示，年龄>65 岁（调整后的危险比[HR]，2.81，95%置信区间[CI]，1.59-4.96；P<0.001）、难治性 AF（调整后的 HR，2.84，95% CI，1.36-5.94；P=0.006）、较低的白蛋白水平（调整后的 HR，0.50，95% CI，0.31-0.82）和 PALS 降低（调整后的 HR，1.87，95% CI，1.06-3.33；P=0.032）是全因死亡率的显著决定因素。PALS 下降与难治性 AF（调整后的 HR，5.74，95% CI，2.81-11.7；P<0.001）和无迷宫手术（调整后的 HR，2.95，95% CI，1.51-5.78；P=0.002）相关。
我们的严重功能性 TR 患者接受 TV 手术后，PALS 的降低与全因死亡率显著相关。这种现象与难治性 AF 有关，需要在 TV 手术时对 AF 进行更积极的干预。
