Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Riyadh, Saudi Arabia.
Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
Braz J Cardiovasc Surg. 2023 Aug 4;38(5):e20230013. doi: 10.21470/1678-9741-2023-0013.
We studied the effect of tricuspid valve (TV) surgery combined with surgical ventricular restoration (SVR) on operative outcomes, rehospitalization, recurrent tricuspid regurgitation, and survival of patients with ischemic cardiomyopathy. Additionally, surgery was compared to conservative management in patients with mild or moderate tricuspid regurgitation. To the best of our knowledge, the advantage of combining TV surgery with SVR in patients with ischemic cardiomyopathy had not been investigated before.
This retrospective cohort study included 137 SVR patients who were recruited from 2009 to 2020. Patients were divided into two groups - those with no concomitant TV surgery (n=74) and those with concomitant TV repair or replacement (n=63).
Extracorporeal membrane oxygenation use was higher in SVR patients without TV surgery (P=0.015). Re-exploration and blood transfusion were significantly higher in those with TV surgery (P=0.048 and P=0.037, respectively). Hospital mortality occurred in eight (10.81%) patients with no TV surgery vs. five (7.94%) in the TV surgery group (P=0.771). Neither rehospitalization (log-rank P=0.749) nor survival (log-rank P=0.515) differed in patients with mild and moderate tricuspid regurgitation in both groups. Freedom from recurrent tricuspid regurgitation was non-significantly higher in mild and moderate tricuspid regurgitation patients with no TV surgery (P=0.059). Conservative management predicted the recurrence of tricuspid regurgitation.
TV surgery concomitant with SVR could reduce the recurrence of tricuspid regurgitation; however, its effect on the clinical outcomes of rehospitalization and survival was not evident. The same effects were observed in patients with mild and moderate tricuspid regurgitation.
我们研究了三尖瓣（TV）手术联合心室修复术（SVR）对缺血性心肌病患者手术结果、再住院、复发性三尖瓣反流和生存率的影响。此外，我们还比较了手术与保守治疗对轻度或中度三尖瓣反流患者的效果。据我们所知，之前尚未研究过在缺血性心肌病患者中联合进行 TV 手术和 SVR 的优势。
本回顾性队列研究纳入了 2009 年至 2020 年间招募的 137 例 SVR 患者。患者分为两组 - 无 TV 手术组（n=74）和 TV 修复或置换组（n=63）。
无 TV 手术的 SVR 患者体外膜氧合使用率更高（P=0.015）。TV 手术组再探查和输血的比例明显更高（P=0.048 和 P=0.037）。无 TV 手术组 8 例（10.81%）患者发生院内死亡，而 TV 手术组 5 例（7.94%）（P=0.771）。两组轻度和中度三尖瓣反流患者的再住院率（log-rank P=0.749）和生存率（log-rank P=0.515）均无差异。无 TV 手术的轻度和中度三尖瓣反流患者的复发性三尖瓣反流发生率非显著更高（P=0.059）。保守治疗可预测三尖瓣反流的复发。
TV 手术联合 SVR 可降低三尖瓣反流的复发率；然而，其对再住院和生存的临床结局的影响并不明显。轻度和中度三尖瓣反流患者也观察到了相同的效果。
