Department of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa.
Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minn.
J Thorac Cardiovasc Surg. 2024 Sep;168(3):853-860.e2. doi: 10.1016/j.jtcvs.2023.07.044. Epub 2023 Aug 2.
Owing to a lack of supportive data, tricuspid regurgitation (TR) is usually not addressed in patients undergoing coronary artery bypass grafting (CABG). Here we evaluated changes in TR degrees over time and its impact on survival in patients undergoing CABG.
We reviewed the data of 9726 patients who underwent isolated CABG between January 2000 and January 2021. According to preoperative TR severity, patients were stratified into nonsignificant (none to trivial, mild) and significant (moderate to severe) TR groups. We excluded patients who had undergone previous tricuspid valve surgery, pacemaker placement, and concomitant valve or ablative surgery. Propensity score matching and Cox proportional hazards models were used to identify associations between TR grade and the primary outcome of all-cause mortality. The secondary outcome was change in TR severity on the last echocardiogram.
After propensity score matching, 380 patients in each group were identified. At baseline, 359 patients had moderate TR (94.5%) and 21 (5.5%) had severe TR. On the last follow-up echocardiogram, TR had improved in 40.5% of the patients in the significant TR group. Kaplan-Meier survival curves showed significantly lower survival in patients with significant preoperative TR compared to those with nonsignificant TR (P < .001). After adjusting for other confounders, survival was no worse in the patients with significant TR group (hazard ratio, 1.05; 95% confidence interval, 0.80-1.38; P = .70).
Significant preoperative TR improved in 40.5% of patients after isolated CABG. After adjusting for other factors, significant TR did not affect long-term survival.
由于缺乏支持性数据，行冠状动脉旁路移植术（CABG）的患者通常不处理三尖瓣反流（TR）。在此，我们评估了 TR 程度随时间的变化及其对 CABG 患者生存的影响。
我们回顾了 2000 年 1 月至 2021 年 1 月期间接受单纯 CABG 的 9726 例患者的数据。根据术前 TR 严重程度，患者分为无明显（无至轻度、轻度）和明显（中度至重度）TR 组。我们排除了既往行三尖瓣手术、起搏器植入以及同期瓣膜或消融手术的患者。采用倾向评分匹配和 Cox 比例风险模型来确定 TR 分级与全因死亡率的主要结局之间的关联。次要结局是最后一次超声心动图上 TR 严重程度的变化。
经倾向评分匹配后，每组各有 380 例患者。基线时，359 例患者为中度 TR（94.5%），21 例（5.5%）为重度 TR。在最后一次随访超声心动图上，明显 TR 组中有 40.5%的患者 TR 得到改善。Kaplan-Meier 生存曲线显示，术前有明显 TR 的患者生存率明显低于无明显 TR 的患者（P<.001）。在调整其他混杂因素后，重度 TR 患者的生存率并不差（风险比，1.05；95%置信区间，0.80-1.38；P=0.70）。
在接受单纯 CABG 治疗的患者中，有 40.5%的患者术前有明显的 TR 得到改善。在调整其他因素后，重度 TR 并不影响长期生存。
