Division of Pediatric Cardiology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
Division of Cardiac, Thoracic, and Vascular Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY.
J Thorac Cardiovasc Surg. 2023 Oct;166(4):1200-1209.e3. doi: 10.1016/j.jtcvs.2023.05.014. Epub 2023 May 22.
In patients with single ventricle physiology and a systemic right ventricle, tricuspid valve regurgitation increases the risk of adverse outcomes, and tricuspid valve intervention at the time of staged palliation further increases that risk in the postoperative period. However, long-term outcomes of valve intervention in patients with significant regurgitation during stage 2 palliation have not been established. The purpose of this study is to evaluate the long-term outcomes after tricuspid valve intervention during stage 2 palliation in patients with right ventricular dominant circulation in a multicenter study.
The study was performed using the Single Ventricle Reconstruction Trial and Single Ventricle Reconstruction Follow-up 2 Trial datasets. Survival analysis was performed to describe the association among valve regurgitation, intervention, and long-term survival. Cox proportional hazards modeling was used to estimate the longitudinal association of tricuspid intervention and transplant-free survival.
Patients with tricuspid regurgitation at stage 1 or 2 had worse transplant-free survival (hazard ratio, 1.61; 95% confidence interval, 1.12-2.32; hazard ratio, 2.3; 95% confidence interval 1.39-3.82). Those with regurgitation who underwent concomitant valve intervention at stage 2 were significantly more likely to die or undergo heart transplantation compared with those with regurgitation who did not (hazard ratio, 2.93; confidence interval, 2.16-3.99). Patients with tricuspid regurgitation at the time of the Fontan had favorable outcomes regardless of valve intervention.
The risks associated with tricuspid regurgitation in patients with single ventricle physiology do not appear to be mitigated by valve intervention at the time of stage 2 palliation. Patients who underwent valve intervention for tricuspid regurgitation at stage 2 had significantly worse survival compared with patients with tricuspid regurgitation who did not.
在单心室生理和右心系统的患者中，三尖瓣反流会增加不良结局的风险，而在分期姑息治疗时进行三尖瓣干预会进一步增加术后风险。然而，在二期姑息治疗中存在大量反流的患者中，瓣膜干预的长期结果尚未确定。本研究旨在评估多中心研究中右心优势循环患者二期姑息治疗时行三尖瓣干预的长期结果。
本研究使用了单心室重建试验和单心室重建随访 2 期试验数据集。生存分析用于描述瓣膜反流、干预和长期生存之间的关系。Cox 比例风险模型用于估计三尖瓣干预和无移植生存的纵向关联。
在 1 期或 2 期有三尖瓣反流的患者无移植生存更差（风险比，1.61；95%置信区间，1.12-2.32；风险比，2.3；95%置信区间 1.39-3.82）。与无反流相比，在 2 期同时行瓣膜干预的反流患者更有可能死亡或接受心脏移植（风险比，2.93；置信区间，2.16-3.99）。在 Fontan 时存在三尖瓣反流的患者，无论是否进行瓣膜干预，结局均良好。
在单心室生理患者中，三尖瓣反流相关风险似乎不会因分期姑息治疗时的瓣膜干预而减轻。在 2 期姑息治疗时因三尖瓣反流而行瓣膜干预的患者，其生存率明显低于无反流而行瓣膜干预的患者。
