Kaneyuki Daisuke, Jordan Andrew M, Rosen Jake L, Macmillan Thomas Reese, Morris Rohinton J, Tchantchaleishvili Vakhtang
Division of Cardiac Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.
Thorac Cardiovasc Surg. 2025 Mar;73(2):111-116. doi: 10.1055/a-2300-6791. Epub 2024 Apr 5.
Severe tricuspid regurgitation (TR) adversely affects long-term survival; however, isolated tricuspid valve (TV) surgery has been rarely performed due to high operative mortality. In addition, the previous literature included heterogeneous TR etiologies. Therefore, we aimed to elucidate early and long-term outcomes of isolated TV surgery for functional TR.
An electronic search was performed to identify all relevant studies. Baseline characteristics, perioperative variables, and clinical outcomes were extracted and pooled for meta-analysis.
This meta-analysis included seven studies. Pooled analyses showed that 68% (35, 89) of patients had preoperative atrial fibrillation or flutter, and 58% (11, 94) had a history of left-sided valve surgery. Seventy-three percent (65, 80) of patients had at least one physical exam finding of right-sided heart failure, and 57% (44, 69) were in New York Heart Association class III or IV. TV replacement was more common than repair. In TV replacement, bioprosthetic valve (39%, 13, 74) was more common than mechanical prosthesis (22%, 18, 26). The early mortality rate was 7%. Twenty percent of patients required a permanent pacemaker postoperatively. The overall 1- and 5-year survival rates were 84.5 and 69.1%, respectively.
More than half of the patients who underwent isolated TV surgery for functional TR had undergone left-sided valve surgery and had significant heart failure symptoms at the time of surgery. Further studies on the surgical indication for concomitant TV surgery at the time of left-sided valve surgery and the appropriate timing of surgery for isolated functional TR are needed to improve survival.
严重三尖瓣反流（TR）对长期生存有不利影响；然而，由于手术死亡率高，单纯三尖瓣（TV）手术很少进行。此外，既往文献中TR的病因各异。因此，我们旨在阐明功能性TR单纯TV手术的早期和长期结果。
进行电子检索以识别所有相关研究。提取基线特征、围手术期变量和临床结果并汇总进行荟萃分析。
该荟萃分析纳入了7项研究。汇总分析显示，68%（35, 89）的患者术前有房颤或房扑，58%（11, 94）有左侧瓣膜手术史。73%（65, 80）的患者至少有一项右侧心力衰竭的体格检查发现，57%（44, 69）为纽约心脏协会III或IV级。TV置换比修复更常见。在TV置换中，生物瓣膜（39%，13, 74）比机械瓣膜（22%，18, 26）更常见。早期死亡率为7%。20%的患者术后需要永久起搏器。总体1年和5年生存率分别为84.5%和69.1%。
接受功能性TR单纯TV手术的患者中，超过一半曾接受过左侧瓣膜手术，且手术时存在明显的心衰症状。需要进一步研究左侧瓣膜手术时同期TV手术的手术指征以及功能性TR单纯手术的合适时机，以提高生存率。
