Choi Jae Woong, Kim Ji Seong, Kang Yoonjin, Sohn Suk Ho, Kim Kyung Hwan, Park Eun-Ah, Hwang Ho Young
Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
Thorac Cardiovasc Surg. 2025 Mar;73(2):104-110. doi: 10.1055/a-2060-5067. Epub 2023 Mar 22.
This study aimed to compare long-term outcomes after tricuspid valve (TV) repair (TVr) with those after TV replacement (TVR) by adjusting the right ventricular (RV) volume and function.
We enrolled 147 patients who underwent TVr ( = 78) and TVR ( = 69) for grade 3 or 4 tricuspid regurgitation and had preoperative cardiac magnetic resonance data. Long-term clinical outcomes were compared between the two groups using inverse probability treatment weighting (IPTW) to adjust for differences in preoperative characteristics between the two groups. Subgroup analyses were performed in patients with preserved and dysfunctional RV (ejection fraction < 50%).
There were no significant differences in operative mortality or postoperative complications between the two groups before and after the IPTW adjustment. Five- and 10-year overall survival rates were 84.2 and 67.1%, respectively. Five- and 10-year cumulative incidences of TV-related events (TVREs) were 33.1 and 55.6%, respectively. There were no significant differences in overall survival and cumulative incidence of TVREs after IPTW adjustment ( = 0.236 and = 0.989, respectively). The risk-adjusted overall survival was marginally higher in the TVr group of patients with preserved RV function ( = 0.054), while no such significant difference was found between the two groups of patients with dysfunctional RV ( = 0.513).
Adjusted long-term clinical outcomes after TVr and TVR were comparable. TVr might be beneficial for patients with preserved RV function in terms of long-term survival; however, this benefit might disappear in patients with RV dysfunction.
本研究旨在通过调整右心室（RV）容量和功能，比较三尖瓣修复术（TVr）与三尖瓣置换术（TVR）后的长期疗效。
我们纳入了147例因3或4级三尖瓣反流接受TVr（n = 78）和TVR（n = 69）且术前有心脏磁共振数据的患者。使用逆概率处理加权（IPTW）对两组术前特征差异进行调整，比较两组的长期临床疗效。对RV功能保留和功能不全（射血分数<50%）的患者进行亚组分析。
IPTW调整前后，两组的手术死亡率或术后并发症均无显著差异。5年和10年总生存率分别为84.2%和67.1%。TV相关事件（TVREs）的5年和10年累积发生率分别为33.1%和55.6%。IPTW调整后，总生存率和TVREs累积发生率无显著差异（分别为P = 0.236和P = 0.989）。RV功能保留的患者中，TVr组的风险调整后总生存率略高（P = 0.054），而RV功能不全的两组患者之间未发现此类显著差异（P = 0.513）。
TVr和TVR调整后的长期临床疗效相当。就长期生存而言，TVr可能对RV功能保留的患者有益；然而，这种益处可能在RV功能不全的患者中消失。
