Kim Kitae, Park Tae Hyun, Yoon Sungsil, Park Soojin, Kim Hong Rae, Kim Ho Jin, Yoo Jae Suk, Jung Sung-Ho, Chung Cheol Hyun, Kim Joon Bum
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
JACC Asia. 2025 Mar;5(3 Pt 2):455-464. doi: 10.1016/j.jacasi.2024.10.014. Epub 2024 Dec 24.
Recent studies on the effects of preoperative tricuspid regurgitation (TR) severity and concomitant tricuspid valve (TV) surgery in patients undergoing aortic valve replacement (AVR) have yielded conflicting results, complicating the decision making on concomitant TV surgery in AVR.
The purpose of this study was to investigate the impact of preoperative TR severity on outcomes of AVR and to assess the impact of concomitant TV surgery.
Patients who underwent AVR from 2000 to 2022 were included. The primary outcome was all-cause mortality, and the secondary outcome was a composite of mortality, TV-related reoperation, stroke, and heart failure. For patients with moderate TR, the impact of TV surgery was analyzed using the inverse probability of treatment weighting to address for selection bias.
A total of 2,679 consecutive patients (median 7.22 years, Q1-Q3: 4.21-11.83 years) constituted the study cohort. At baseline, TR severity was none-to-trivial, mild, moderate, and severe in 1,688 (63.0%), 731 (27.3%), 215 (8.0%), and 45 (1.7%) patients, respectively. Clinical outcomes demonstrated significant disparities depending on baseline TR severity (P for trend < 0.001). After adjusting for potential covariates, TV surgery did not affect overall survival among patients with moderate TR (HR: 0.57; 95% CI: 0.21-1.50). However, the TV surgery group exhibited a favorable composite outcome and lower TV-related reoperation rate (HR: 0.37; 95% CI: 0.15-0.92, and subdistribution HR: 0.07; 95% CI: 0.01-0.63, respectively).
In patients who underwent AVR, baseline TR severity correlated with unfavorable clinical outcomes. Concomitant TV surgery reduced the rate of TV-related reoperations, but not mortality, among patients with moderate TR.
近期关于主动脉瓣置换术（AVR）患者术前三尖瓣反流（TR）严重程度及同期三尖瓣（TV）手术影响的研究结果相互矛盾，这使得AVR同期TV手术的决策变得复杂。
本研究旨在探讨术前TR严重程度对AVR结局的影响，并评估同期TV手术的影响。
纳入2000年至2022年接受AVR的患者。主要结局为全因死亡率，次要结局为死亡、TV相关再次手术、卒中及心力衰竭的复合结局。对于中度TR患者，采用治疗权重逆概率分析TV手术的影响，以解决选择偏倚问题。
共2679例连续患者（中位年龄7.22岁，四分位间距：4.21 - 11.83岁）构成研究队列。基线时，1688例（63.0%）、731例（27.3%）、215例（8.0%）和45例（1.7%）患者的TR严重程度分别为无至轻微、轻度、中度和重度。临床结局因基线TR严重程度而异（趋势P<0.001）。调整潜在协变量后，TV手术对中度TR患者的总生存率无影响（HR：0.57；95%CI：0.21 - 1.50）。然而，TV手术组的复合结局良好，TV相关再次手术率较低（HR分别为：0.37；95%CI：0.15 - 0.92，以及亚分布HR：0.07；95%CI：0.01 - 0.63）。
在接受AVR的患者中，基线TR严重程度与不良临床结局相关。同期TV手术降低了中度TR患者TV相关再次手术率，但未降低死亡率。
