心内膜炎在单纯三尖瓣手术中的预后作用。一项倾向评分加权研究。
Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study.
作者信息
Di Mauro Michele, Russo Marco, Saitto Guglielmo, Lio Antonio, Berretta Paolo, Taramasso Maurizio, Scrofani Roberto, Della Corte Alessandro, Sponga Sandro, Greco Ernesto, Saccocci Matteo, Calafiore Antonio, Bianchi Giacomo, Leviner Dror B, Biondi Andrea, Livi Ugolino, Sharoni Erez, De Vincentiis Carlo, Di Eusanio Marco, Antona Carlo, Troise Giovanni, Solinas Marco, Laufer Guenther, Musumeci Francesco, Andreas Martin
机构信息
Cardio-Thoracic Surgery Unit, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
Department of Cardiac Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria; Department of Cardiac Surgery and Heart Transplantation, San Camillo Forlanini Hospital, Rome, Italy.
出版信息
Int J Cardiol. 2023 Jan 15;371:116-120. doi: 10.1016/j.ijcard.2022.09.020. Epub 2022 Sep 13.
OBJECTIVES
The role of the underlying etiology in isolated tricuspid valve surgery has not been investigated extensively in current literature. Aim of this study was to analyse outcomes of patients undergoing surgery due to endocarditis compared to other pathologies.
METHODS
The SURTRI study is a multicenter study enrolling adult patients who underwent isolated tricuspid valve surgery (n = 406, 55 ± 16 y.o.; 56% female) at 13 international sites. Propensity weighted analysis was performed to compare groups (IE group n = 107 vs Not-IE group n = 299).
RESULTS
No difference was found regarding the 30-day mortality (Group IE: 2.8% vs Group Not-IE = 6.8%; OR = 0.45) and major adverse events. Weighted cumulative incidence of cardiac death was significantly higher for patients with endocarditis (p = 0.01). The composite endpoint of cardiac death and reoperation at 6 years was reduced in the Group IE (63.2 ± 6.8% vs 78.9 ± 3.1%; p = 0.022). Repair strategy resulted in an increased late survival even in IE cases.
CONCLUSIONS
Data from SURTRI study report acceptable 30-day results but significantly reduced late survival in the setting of endocarditis of the tricuspid valve. Multi-disciplinary approach, repair strategy and earlier treatment may improve outcomes.
目的
目前文献中尚未对潜在病因在单纯三尖瓣手术中的作用进行广泛研究。本研究的目的是分析因感染性心内膜炎接受手术的患者与其他病理情况患者的手术结果。
方法
SURTRI研究是一项多中心研究，纳入了在13个国际地点接受单纯三尖瓣手术的成年患者（n = 406，年龄55±16岁；56%为女性）。进行倾向加权分析以比较各组（感染性心内膜炎组n = 107 vs非感染性心内膜炎组n = 299）。
结果
30天死亡率（感染性心内膜炎组：2.8% vs非感染性心内膜炎组 = 6.8%；OR = 0.45）和主要不良事件方面未发现差异。感染性心内膜炎患者的心源性死亡加权累积发生率显著更高（p = 0.01）。感染性心内膜炎组6年时的心源性死亡和再次手术复合终点降低（63.2±6.8% vs 78.9±3.1%；p = 0.022）。修复策略即使在感染性心内膜炎病例中也能提高晚期生存率。
结论
SURTRI研究的数据显示30天结果尚可，但三尖瓣感染性心内膜炎患者的晚期生存率显著降低。多学科方法、修复策略和早期治疗可能改善手术结果。
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