Sawma Tedy, Schaff Hartzell V, Geske Jeffrey B, Dearani Joseph A, Ommen Steve R
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minn.
JTCVS Open. 2024 Jun 27;20:29-36. doi: 10.1016/j.xjon.2024.06.011. eCollection 2024 Aug.
Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of developing cardiac arrhythmias and have a high prevalence of cardiac implantable electronic device (CIED) use. Tricuspid regurgitation (TR) is a potential complication of device leads and can be severe enough to prompt surgical intervention.
We identified 21 consecutive patients who underwent tricuspid valve (TV) surgery for device lead-induced TR late following septal myectomy (SM) for obstructive HCM. The primary endpoint was long-term all-cause mortality.
The median patient age was 63 years (range, 55-71 years), 19 patients (91%) had New York Heart Association class III or IV limitation, and all patients were receiving diuretics for right heart failure. The median interval between device implantation and TV surgery was 4 years (range, 1.5-8.5 years). Eight patients (38%) underwent pacemaker implantation due to complete heart block following SM. Preoperatively, TR was severe in 81% of the patients. The primary mechanism of lead-induced TR was leaflet impingement without adherence (n = 15; 75%). Nine patients (43%) underwent TV replacement, and 12 patients (57%) underwent repair. Only 1 patient died early postoperatively. Patients with lead-induced TR had markedly reduced long-term survival compared to the overall population of patients undergoing SM; 5-year survival was 58%, compared to 96% for the contemporary SM group.
Late lead-induced TR is a potential complication of CIEDs in patients with HCM who have undergone SM. Although TV repair and replacement can be done with acceptable early mortality, late patient survival is poor.
肥厚型心肌病（HCM）患者发生心律失常的风险增加，心脏植入式电子设备（CIED）的使用率很高。三尖瓣反流（TR）是设备导线的潜在并发症，严重时可促使进行手术干预。
我们确定了21例因梗阻性HCM行室间隔心肌切除术（SM）后晚期因设备导线导致TR而接受三尖瓣（TV）手术的连续患者。主要终点是长期全因死亡率。
患者中位年龄为63岁（范围55 - 71岁），19例患者（91%）有纽约心脏协会III或IV级功能受限，所有患者均因右心衰竭接受利尿剂治疗。设备植入与TV手术之间的中位间隔时间为4年（范围1.5 - 8.5年）。8例患者（38%）因SM后完全性心脏传导阻滞接受了起搏器植入。术前，81%的患者TR严重。导线导致TR的主要机制是瓣叶受撞击但无粘连（n = 15；75%）。9例患者（43%）接受了TV置换，12例患者（57%）接受了修复。仅1例患者术后早期死亡。与接受SM的总体患者群体相比，因导线导致TR的患者长期生存率明显降低；5年生存率为58%，而当代SM组为96%。
晚期导线导致的TR是接受SM治疗的HCM患者CIED的潜在并发症。虽然TV修复和置换可在可接受的早期死亡率下进行，但患者晚期生存率较差。
