Furuta Akihisa, Shinkawa Takeshi, Okugi Satoshi, Yoshida Hisashi, Niinami Hiroshi
Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan.
JTCVS Open. 2023 Jul 6;15:382-393. doi: 10.1016/j.xjon.2023.06.013. eCollection 2023 Sep.
The purpose of this study is to compare the long-term outcomes of 2 different tricuspid surgeries including valvuloplasty and replacement for significant tricuspid regurgitation in patients with systemic right ventricle.
This is a retrospective study of 34 patients with dextro-transposition of the great arteries or levo-transposition of the great arteries with biventricular circulation and systemic right ventricle undergoing tricuspid valve surgery between April 1979 and April 2022. Patients were divided into 2 groups based on the procedure: tricuspid valvuloplasty (n = 11) and tricuspid valve replacement (n = 23). These groups were compared in terms of survival, tricuspid valve dysfunction, and tricuspid valve-related reoperation.
There was no significant difference between the groups in operative age, body weight, the proportion of dextro-transposition of the great arteries, Ebstein-like tricuspid dysplasia, and preoperative right ventricular volume/function. During the median follow-up of 9.7 years, there was 1 early death (tricuspid valvuloplasty group) and 4 late deaths (3 in tricuspid valvuloplasty group and 1 in tricuspid valve replacement group). There were 7 tricuspid valve dysfunctions, including 6 significant tricuspid regurgitations in the tricuspid valvuloplasty group and 1 prosthetic valve dysfunction in the tricuspid valve replacement group, and 4 tricuspid valve-related reoperations (3 in the tricuspid valvuloplasty group and 1 in the tricuspid valve replacement group) were performed. There were significant differences between the groups in survival (tricuspid valvuloplasty vs tricuspid valve replacement: 72.7 vs 94.7% at 10 years after surgery, = .0328) and cumulative incidence of tricuspid valve dysfunction at 10 years after tricuspid surgery (tricuspid valvuloplasty vs tricuspid valve replacement: 27.3% vs 0%, = .0121).
Tricuspid valve replacement provided better long-term survival and tricuspid function in patients with systemic right ventricle compared with tricuspid valvuloplasty.
本研究旨在比较两种不同的三尖瓣手术（包括瓣膜成形术和置换术）对右心室功能不全患者严重三尖瓣反流的长期疗效。
这是一项回顾性研究，纳入了1979年4月至2022年4月期间接受三尖瓣手术的34例大动脉右旋位或左旋位且双心室循环及右心室功能不全的患者。根据手术方式将患者分为两组：三尖瓣瓣膜成形术组（n = 11）和三尖瓣瓣膜置换术组（n = 23）。比较两组患者的生存率、三尖瓣功能障碍及三尖瓣相关再次手术情况。
两组患者在手术年龄、体重、大动脉右旋位比例、埃布斯坦样三尖瓣发育异常及术前右心室容积/功能方面无显著差异。中位随访9.7年期间，有1例早期死亡（三尖瓣瓣膜成形术组）和4例晚期死亡（三尖瓣瓣膜成形术组3例，三尖瓣瓣膜置换术组1例）。发生7例三尖瓣功能障碍，其中三尖瓣瓣膜成形术组有6例严重三尖瓣反流，三尖瓣瓣膜置换术组有1例人工瓣膜功能障碍，且进行了4例三尖瓣相关再次手术（三尖瓣瓣膜成形术组3例，三尖瓣瓣膜置换术组1例）。两组患者在生存率（三尖瓣瓣膜成形术与三尖瓣瓣膜置换术：术后10年分别为72.7%和94.7%，P = 0.0328）及三尖瓣手术后10年三尖瓣功能障碍累积发生率（三尖瓣瓣膜成形术与三尖瓣瓣膜置换术：分别为27.3%和0%，P = 0.0121）方面存在显著差异。
与三尖瓣瓣膜成形术相比，三尖瓣瓣膜置换术为右心室功能不全患者提供了更好的长期生存率和三尖瓣功能。
