Baudo Massimo, Cuko Besart, Ternacle Julien, Magrini Elena, Busuttil Olivier, Dib Nabil, Sicouri Serge, Labrousse Louis, Modine Thomas, Ramlawi Basel
Department of Cardiac Surgery Research, Lankenau Institute for Medical Research, Main Line Health, Wynnewood, PA.
Department of Cardiology and Cardio-Vascular Surgery, Hopital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Pessac, France.
Surgery. 2025 Jul;183:109370. doi: 10.1016/j.surg.2025.109370. Epub 2025 Apr 23.
Although the management of tricuspid regurgitation during mitral surgery is standardized, the approach to patients with isolated tricuspid regurgitation is less clearly defined. This study examined the surgical outcomes of patients who underwent isolated surgical tricuspid valve replacement at 2 medical centers, providing insights into the postoperative and midterm outcomes.
This retrospective observational study analyzed data from 2 tertiary cardiac surgery centers. All patients underwent isolated surgical tricuspid valve replacement between 2010 and 2023. The primary end point included 30-day and midterm survival. The secondary end points included postoperative and valve-related complications.
A total of 64 patients were included. The mean age was 58 ± 17 years, and 51.6% (33/64) were male patients. The median European System for Cardiac Operative Risk Evaluation II, TRISCORE, and Model for End-Stage Liver Disease scores were 2.16 [1.38-3.42], 3.00 [1.00-4.00], and 10.50 [9.00-16.25], respectively. More than 60% of the procedures were conducted on a beating heart. Thirty-day mortality was 7.8%. European System for Cardiac Operative Risk Evaluation II underestimated mortality, whereas the Model for End-Stage Liver Disease score was a more reliable predictor. Ten patients finally received a permanent pacemaker upon discharge. The overall survival rates at 1 and 6 years were 88.8 ± 4.0% and 80.3 ± 7.3%, respectively. Freedom from tricuspid valve reintervention rates at 1 and 6 years were 96.2 ± 2.6% and 75.0 ± 9.6%, respectively.
This study demonstrated that isolated surgical tricuspid valve replacement can be undertaken without exposing patients to an excessively high mortality risk. Risk assessment using specific scores may be useful in this regard. Nevertheless, these patients are at risk of postoperative complications, particularly permanent pacemaker implantation.
尽管二尖瓣手术期间三尖瓣反流的管理已标准化，但对于孤立性三尖瓣反流患者的治疗方法尚不太明确。本研究调查了在2个医疗中心接受孤立性外科三尖瓣置换术患者的手术结果，以深入了解术后和中期结果。
这项回顾性观察性研究分析了来自2个三级心脏外科中心的数据。所有患者在2010年至2023年期间接受了孤立性外科三尖瓣置换术。主要终点包括30天和中期生存率。次要终点包括术后和瓣膜相关并发症。
共纳入64例患者。平均年龄为58±17岁，男性患者占51.6%（33/64）。欧洲心脏手术风险评估系统II、TRISCORE和终末期肝病模型评分的中位数分别为2.16[1.38 - 3.42]、3.00[1.00 - 4.00]和10.50[9.00 - 16.25]。超过60%的手术是在心脏跳动的情况下进行的。30天死亡率为7.8%。欧洲心脏手术风险评估系统II低估了死亡率，而终末期肝病模型评分是一个更可靠的预测指标。10例患者出院时最终接受了永久性起搏器植入。1年和6年的总生存率分别为88.8±4.0%和80.3±7.3%。1年和6年三尖瓣再次干预的无事件发生率分别为96.2±2.6%和75.0±9.6%。
本研究表明，孤立性外科三尖瓣置换术不会使患者面临过高的死亡风险。在这方面，使用特定评分进行风险评估可能会有所帮助。然而，这些患者有术后并发症的风险，特别是永久性起搏器植入。
