Brancaccio Gianluca, Bordonaro Veronica, Trezzi Matteo, Chinali Marcello, Fugallo Delia, D'Anna Carolina, Lisignoli Veronica, Verrengia Marin, Miraldi Fabio, Butera Gianfranco, Iacobelli Roberta, Leonardi Benedetta, Montanaro Claudia, Secinaro Aurelio, Galletti Lorenzo
Pediatric Cardiac Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Advanced Cardiothoracic Imaging Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Int J Cardiol Congenit Heart Dis. 2025 Mar 13;20:100577. doi: 10.1016/j.ijcchd.2025.100577. eCollection 2025 Jun.
The emerging role of tricuspid regurgitation in the long-term outcome of the general population, poses the need for a review of its impact on patients with TOF and the timing for surgical PVR.
This is a retrospective, single Centre study. Clinical, imaging and surgical data of adults with repaired TOF with a transannular patch repair were collected from our database.
149 patients (61 % male, mean age of 26.0 years) were selected. At a follow-up time of 25.5 years (95 % CI 24.5,26.4) 92 patients required isolated PVR at a mean time from TOF repair of 16.6 years (95 % CI 15.5,17.7) and at a mean age of 17.9 years (95 % CI 16.8,19.0). In the whole cohort, significant TR was associated with a two-fold increase likelihood of requiring PVR (log-rank p = 0-0.0023, HR 2.02; 1.09-4-47). Moderate to severe TR was more frequent in those who underwent VSD closure through a right atriotomy (17 versus 0, p = 0.0002) and affected time to PVR (22.10 yrs versus 18.07 yrs). Despite significant RV volume overload, only 16 % of the entire cohort had TR more than moderate, and the degree of TR and tricuspid valve annulus diameter correlated better with atrial rather than ventricular volumes and areas (r = 0.346; = 0.0068).
TR severity of adults with transannula pacth repair of TOF correlats with surgical type of VSD closure and confers a two-fold increase in the likelihood of requiring PVR during follow-up. The close correlation of TV with atrial rather than ventricular volumes in this cohort suggests a link with the non-functional nature of TR.
三尖瓣反流在普通人群长期预后中的新作用，使得有必要重新审视其对法洛四联症（TOF）患者的影响以及外科肺动脉瓣置换术（PVR）的时机。
这是一项回顾性单中心研究。从我们的数据库中收集了经跨环补片修复的TOF修复成年患者的临床、影像学和手术数据。
共选取149例患者（61%为男性，平均年龄26.0岁）。在25.5年的随访期（95%可信区间24.5,26.4），92例患者需要单独进行PVR，平均时间为TOF修复后16.6年（95%可信区间15.5,17.7），平均年龄为17.9岁（95%可信区间16.8,19.0）。在整个队列中，严重三尖瓣反流与需要进行PVR的可能性增加两倍相关（对数秩检验p = 0 - 0.0023，风险比2.02；1.09 - 4.47）。中重度三尖瓣反流在通过右心房切开术关闭室间隔缺损的患者中更为常见（17例比0例，p = 0.0002），且影响到进行PVR的时间（22.10年比18.07年）。尽管右心室存在明显的容量超负荷，但整个队列中只有16%的患者三尖瓣反流超过中度，三尖瓣反流程度和三尖瓣瓣环直径与心房容积和面积的相关性优于心室容积和面积（r = 0.346；p = 0.0068）。
经跨环补片修复TOF的成年患者的三尖瓣反流严重程度与室间隔缺损关闭的手术方式相关，并且在随访期间需要进行PVR的可能性增加两倍。在该队列中，三尖瓣与心房容积而非心室容积密切相关，提示与三尖瓣反流的无功能性质有关。
