Kim Jihoon, Lee Heemoon, Jung Ji-Hyun, Yoo Jae Suk
Department of Thoracic and Cardiovascular Surgery, Kangnam Sacred Heart Hospital, Hallym University Medical Center, Hallym University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Bucheon Sejong Hospital, Bucheon, Korea.
Korean Circ J. 2023 Nov;53(11):775-786. doi: 10.4070/kcj.2023.0108.
Tricuspid valve (TV) repair techniques other than annuloplasty remain challenging and frequently end in tricuspid valve replacement (TVR) in complicated cases. However, the results of TVR are suboptimal compared with TV repair. This study aimed to evaluate the clinical effectiveness of TV edge-to-edge repair (E2E) compared to TVR for severe tricuspid regurgitation (TR).
We retrospectively reviewed 230 patients with severe TR who underwent E2E (n=139) or TVR (n=91) from 2001 to 2020. Clinical and echocardiographic results were analyzed using inverse probability of treatment weighting analysis and propensity score matching.
The two groups showed no significant differences in early mortality and morbidities. During the mean follow-up of 106.2±68.8 months, late severe TR and TV reoperation rates were not significantly different between groups. E2E group, however, showed better outcomes in overall survival (p=0.023), freedom from significant tricuspid stenosis (TS) (trans-tricuspid pressure gradient ≥5 mmHg, p=0.021), and freedom from TV-related events (p<0.001). Matched analysis showed consistent results.
E2E for severe TR presented more favorable clinical outcomes than TVR. Our study supports that E2E might be a valuable option in severe TR surgery, avoiding TVR.
除瓣环成形术外，三尖瓣修复技术仍具有挑战性，在复杂病例中常以三尖瓣置换术（TVR）告终。然而，与三尖瓣修复相比，TVR的效果并不理想。本研究旨在评估三尖瓣缘对缘修复术（E2E）与TVR治疗重度三尖瓣反流（TR）的临床效果。
我们回顾性分析了2001年至2020年期间接受E2E（n = 139）或TVR（n = 91）的230例重度TR患者。使用治疗权重逆概率分析和倾向评分匹配对临床和超声心动图结果进行分析。
两组在早期死亡率和发病率方面无显著差异。在平均106.2±68.8个月的随访期间，两组晚期重度TR和TV再次手术率无显著差异。然而，E2E组在总生存率（p = 0.023）、无严重三尖瓣狭窄（TS）（跨三尖瓣压力梯度≥5 mmHg，p = 0.021）和无TV相关事件（p < 0.001）方面表现出更好的结果。匹配分析显示了一致的结果。
重度TR的E2E手术比TVR具有更有利的临床结果。我们的研究支持E2E可能是重度TR手术中一个有价值的选择，可避免TVR。
