Shimoda Tomonari M, Ueyama Hiroki A, Miyamoto Yoshihisa, Watanabe Atsuyuki, Gotanda Hiroshi, Elmariah Sammy, Yokoyama Yujiro, Fukuhara Shinichi, Kaneko Tsuyoshi, Kuno Toshiki, Tsugawa Yusuke
Department of Medicine, University of Tsukuba Hospital, Ibaraki, Japan.
Division of Cardiology, Emory University School of Medicine, Atlanta, Ga.
JTCVS Open. 2024 Oct 28;24:127-146. doi: 10.1016/j.xjon.2024.10.018. eCollection 2025 Apr.
Evidence is limited regarding early-term outcomes after isolated tricuspid operations for tricuspid regurgitation (TR). We compared the early-term outcomes after isolated tricuspid valve replacement versus repair using the contemporary data.
We analyzed the national data on Medicare beneficiaries aged ≥65 years who underwent isolated tricuspid valve replacement or repair for TR between January 2016 and December 2020. The primary outcome was early-term (up to 3 years) all-cause mortality. The secondary outcomes included early-term major adverse cardiovascular events (MACE) and heart failure hospitalizations. MACE encompassed all-cause mortality, heart failure hospitalization, stroke, and tricuspid reoperations. A propensity score matching analysis was conducted to compare between replacement and repair.
A total of 1501 patients were included (replacement: 610 patients, repair: 891 patients). In the matched cohort (n = 547 in each group), the overall mortality and MACE were 39% and 46% at 3 years, respectively. Tricuspid valve replacement was associated with similar all-cause mortality in comparison to repair (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.86-1.30; = .600). Similarly, the rates of MACE and heart failure hospitalizations were similar (adjusted HR, 1.01; 95% CI, 0.84-1.22, = .910; subdistribution HR, 1.04; 95% CI, 0.72-1.49, = .850, respectively) between these 2 procedures.
Isolated surgical tricuspid valve replacement was associated with similar clinical outcomes compared to repair. Importantly, the high overall early-term mortality and morbidity with either treatment underscores the need for alternative intervention choices and further research to optimize the indication and timing of intervention.
关于三尖瓣反流（TR）单纯三尖瓣手术的早期结局，证据有限。我们使用当代数据比较了单纯三尖瓣置换术与修复术后的早期结局。
我们分析了2016年1月至2020年12月期间年龄≥65岁、因TR接受单纯三尖瓣置换术或修复术的医疗保险受益人的全国数据。主要结局是早期（长达3年）全因死亡率。次要结局包括早期主要不良心血管事件（MACE）和心力衰竭住院。MACE包括全因死亡率、心力衰竭住院、中风和三尖瓣再次手术。进行倾向评分匹配分析以比较置换术和修复术。
共纳入1501例患者（置换术：610例患者，修复术：891例患者）。在匹配队列中（每组n = 547），3年时的总体死亡率和MACE分别为39%和46%。与修复术相比，三尖瓣置换术的全因死亡率相似（调整后风险比[HR]，1.06；95%置信区间[CI]，0.86 - 1.30；P = 0.600）。同样，这两种手术的MACE和心力衰竭住院率相似（调整后HR，1.01；95% CI，0.84 - 1.22，P = 0.910；亚分布HR，1.04；95% CI，0.72 - 1.49，P = 0.850）。
与修复术相比，单纯外科三尖瓣置换术的临床结局相似。重要的是，两种治疗方法早期总体死亡率和发病率都很高，这突出了需要其他干预选择，并进一步研究以优化干预的适应症和时机。
