Nammalwar Shruthi, Tam Derrick Y, Alabbadi Sundos, Razavi Allen A, Sallam Aminah, Hasan Irsa, Emerson Dominic, Bowdish Michael E, Egorova Natalia, Chikwe Joanna
Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, Calif.
Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY.
J Thorac Cardiovasc Surg. 2025 Apr 30. doi: 10.1016/j.jtcvs.2025.03.021.
Early and late outcomes of isolated tricuspid surgery in contemporary practice are poorly defined. This statewide analysis evaluated the early and late outcomes of isolated tricuspid repair and replacement.
From the Department of Health Care Access and Information of California State admissions database, 3706 patients who underwent isolated tricuspid repair (2419, 65.3%) or replacement (1287, 34.7%) between 1991 and 2020 were identified. Propensity score matching to adjust for 25 differences in baseline characteristics yielded 789 well-matched pairs. The primary outcome was all-cause mortality compared using Cox proportional hazards. The cumulative incidence of tricuspid reoperation and permanent pacemaker were compared in the Fine-Gray model with death as a competing risk. Median follow-up was 4.4 years (range, 0-30 years).
Isolated tricuspid operations increased from 48 in 1991 to 207 in 2021 (P < .001). Patients undergoing repair were similar in age (53.5 vs 54.5 years, P = .17), more often men (44% vs 40% P = .03), and less likely to have endocarditis (21.5% vs 26.8%, P = .002) compared with patients undergoing replacement. Operative mortality was similar between repair and replacement (8.2% vs 9.9%, P = .27), whereas pacemaker rates were higher after replacement (13.7% vs 32.3%, P < .001). Tricuspid repair was associated with reduced mortality at 25 years compared with replacement (58.1% vs 65.5%; hazard ratio, 0.81, 95% CI, 0.70-0.94, P = .005). The cumulative incidence of reoperation was lower with repair (5.6% vs 11.1%, hazard ratio, 0.57, 95% CI, 0.37-0.88, P = .01).
Tricuspid valve repair is associated with superior early and late outcomes compared with replacement in a statewide administrative dataset.
在当代实践中，单纯三尖瓣手术的早期和晚期结果尚不明确。本全州范围的分析评估了单纯三尖瓣修复和置换的早期和晚期结果。
从加利福尼亚州医疗保健准入与信息部的入院数据库中，识别出1991年至2020年间接受单纯三尖瓣修复（2419例，65.3%）或置换（1287例，34.7%）的3706例患者。采用倾向评分匹配法对25项基线特征差异进行调整，得到789对匹配良好的病例。使用Cox比例风险模型比较全因死亡率这一主要结局。在以死亡作为竞争风险的Fine-Gray模型中比较三尖瓣再次手术和永久起搏器植入的累积发生率。中位随访时间为4.4年（范围0至30年）。
单纯三尖瓣手术从1991年的48例增加到2021年的207例（P < .001）。与接受置换的患者相比，接受修复的患者年龄相近（53.5岁对54.5岁，P = .17），男性比例更高（44%对40%，P = .03），患心内膜炎的可能性更低（21.5%对26.8%，P = .002）。修复和置换后的手术死亡率相似（8.2%对9.9%，P = .27），而置换后起搏器植入率更高（13.7%对32.3%，P < .001）。与置换相比，三尖瓣修复与25年时较低的死亡率相关（58.1%对65.5%；风险比，0.81，95%CI，0.70 - 0.94，P = .005）。修复后的再次手术累积发生率更低（5.6%对11.1%，风险比，0.57，95%CI，0.37 - 0.88，P = .01）。
在全州范围的行政数据集中，与置换相比，三尖瓣修复的早期和晚期结果更佳。
