Piperata Antonio, Van den Eynde Jef, Marin-Cuartas Mateo, Bortolussi Giacomo, Fila Petr, Walter Tim, Sarıcaoğlu Mehmet Cahit, Gofus Jan, Rajdeep Bilkhu, Sá Michel Pompeu, Rosati Fabrizio, De la Cuesta Manuela, Gastino Elisa, Cuko Besart, Ternacle Julien, de Vincentiis Carlo, Czerny Martin, Akar Ahmet Rüçhan, Lucchese Gianluca, Ramlawi Basel, Borger Michael A, Modine Thomas
Medico-Surgical Department (Valvulopathies, Cardiac Surgery, Adult Interventional Cardiology), Hôpital Cardiologique de Haut-Lévèque, Bordeaux University Hospital, Bordeaux, France.
Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
Eur J Cardiothorac Surg. 2025 Mar 28;67(4). doi: 10.1093/ejcts/ezaf107.
Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses.
This multicentre retrospective study included patients from 10 high-volume centres in 7 different countries, who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed. Long-term outcomes were investigated using Kaplan-Meier estimates, Cox regression, and competing risk analysis.
Of 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53%), while 317 (47%) underwent concomitant procedures. Between these 2 groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multi-organ failure, longer intensive care unit and hospital stay and higher 30-day mortality over patients who underwent isolated procedure. The overall 30-day mortality occurred in 70 patients (10.4%) [46 (14.6%) combined vs 24 (6.74%) isolated, P = 0.001]. During the follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at 5, 10 and 15 years being 27.2%, 46.2% and 60.6%, respectively. In contrast, the risk of reintervention starts to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1%, 10.8% and 23.3%, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis and major thromboembolic events at 15 years were 56.5%, 77.3%, 84.0% and 86.4%, respectively.
Tricuspid valve replacement with bioprostheses is an effective treatment for valvular disease, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.
关于生物瓣三尖瓣置换术的长期证据稀缺。本研究旨在调查接受生物瓣三尖瓣置换术患者的长期临床结局。
这项多中心回顾性研究纳入了来自7个不同国家10个大容量中心的接受生物瓣三尖瓣置换术的患者。对超声心动图和临床数据进行了回顾。使用Kaplan-Meier估计、Cox回归和竞争风险分析来研究长期结局。
在675例患者中，358例（53%）接受了单纯三尖瓣置换术，而317例（47%）接受了同期手术。在这两组患者中，接受联合手术的患者感染、房室传导阻滞、多器官功能衰竭的发生率显著更高，重症监护病房和住院时间更长，30天死亡率也高于接受单纯手术的患者。总体30天死亡率发生在70例患者中（10.4%）[联合手术组46例（14.6%） vs 单纯手术组24例（6.74%），P = 0.001]。在随访期间，因死亡导致的失访率持续存在，5年、10年和15年的累积死亡率分别为27.2%、46.2%和60.6%。相比之下，随访10年后再次干预的风险开始显著增加，再次干预的累积发生率分别为6.1%、10.8%和23.3%。15年时无三尖瓣再次干预、起搏器植入、三尖瓣心内膜炎和重大血栓栓塞事件的发生率分别为56.5%、77.3%、84.0%和86.4%。
生物瓣三尖瓣置换术是瓣膜疾病的有效治疗方法，尽管其早期和长期死亡率相对较高。然而，10年后结构性瓣膜退变的风险显著增加。
