Raza Samad, Shrestha Bishwo, Doig Fiona, Pohlner Peter, Jalali Homayoun, Naidoo Rishendran
Division of Cardiothoracic Surgery, Heart and Lung Institute, The Prince Charles Hospital, Brisbane, QLD, Australia.
Interdiscip Cardiovasc Thorac Surg. 2024 Dec 25;40(1). doi: 10.1093/icvts/ivae229.
There is limited consensus on the optimal strategy for surgical treatment of severe tricuspid valve pathology. At our institution, we have implemented a unique technique of using a tricuspid homograft with its supporting apparatus for partial replacement of the native tricuspid valve. We now present the long-term outcomes of these patients.
We analysed a cohort of patients who underwent partial tricuspid valve replacement using tricuspid homograft. Yearly clinical and echocardiographic follow-up was performed. Fine-Gray methods were used to estimate freedom from death and reoperation and reverse Kaplan-Meier methods were used to calculate follow-up.
Fourteen patients were included (age range 15 days to 73 years). Indications included congenital anomalies (n = 9, 64%) and infective endocarditis (n = 5, 36%). The median follow-up was 17 years (95% confidence interval (CI) 10-21 years). Two patients (14%) died due to causes unrelated to the primary tricuspid valve surgery, and three (21%) underwent redo tricuspid valve operations. In the remaining cohort, seven (50%) were asymptomatic and two (14%) reported class II dyspnoea, while none had severe tricuspid regurgitation on echocardiogram. Estimated freedom from death was 93% at 10 years and 83% at 15 and 20 years, while estimated freedom from reoperation was 77% at 10, 15 and 20 years.
Partial replacement of the tricuspid valve using tricuspid homograft tissue effectively restores the anatomical conformity of the native tricuspid valve and has durable long-term survival and freedom from severe tricuspid regurgitation in patients with congenital anomalies and infective endocarditis.
对于严重三尖瓣病变的手术治疗最佳策略，目前尚无定论。在我们机构，我们实施了一种独特的技术，即使用带支撑装置的三尖瓣同种异体移植物进行自体三尖瓣部分置换。我们现在报告这些患者的长期结局。
我们分析了一组接受三尖瓣同种异体移植物部分置换术的患者。每年进行临床和超声心动图随访。采用Fine-Gray方法估计无死亡和再次手术生存率，采用反向Kaplan-Meier方法计算随访情况。
纳入14例患者（年龄范围15天至73岁）。适应症包括先天性异常（n = 9，64%）和感染性心内膜炎（n = 5，36%）。中位随访时间为17年（95%置信区间（CI）10 - 21年）。2例患者（14%）因与原发性三尖瓣手术无关的原因死亡，3例（21%）接受了再次三尖瓣手术。在其余队列中，7例（50%）无症状，2例（14%）报告有Ⅱ级呼吸困难，而超声心动图检查均无严重三尖瓣反流。10年时估计无死亡生存率为93%，15年和20年时为83%，而10年、15年和20年时估计无再次手术生存率为77%。
使用三尖瓣同种异体移植物组织进行三尖瓣部分置换可有效恢复自体三尖瓣的解剖结构，对于先天性异常和感染性心内膜炎患者具有持久的长期生存率且无严重三尖瓣反流。
