Misumi Yusuke, Kainuma Satoshi, Yoshioka Daisuke, Kawamura Takuji, Kawamura Ai, Yajima Shin, Saito Shunsuke, Yamauchi Takashi, Taira Masaki, Shimamura Kazuo, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.
Front Cardiovasc Med. 2025 May 14;12:1542619. doi: 10.3389/fcvm.2025.1542619. eCollection 2025.
We elucidated the impact of concomitant tricuspid annuloplasty (TAP) on postoperative tricuspid regurgitation (TR), pulmonary hypertension (PH) and survival in patients with ischemic cardiomyopathy undergoing restrictive mitral annuloplasty (RMA).
This study included 234 patients with ischemic cardiomyopathy (LV ejection fraction ≤40%) who underwent RMA. Of them, 114 (49%) underwent concomitant TAP for secondary TR. The primary endpoint was freedom from significant recurrence (i.e., moderate or greater) and progression (≥2+ grades) in TR. The secondary endpoints were postoperative pulmonary artery systolic pressure (sPAP) and overall survival.
The 30-day mortality was not different (0.9% vs. 0.8%, = 0.97), despite higher EuroSCORE II score (median, 9.3% vs. 7.2%, = 0.016) for TAP group. At baseline, TAP group had higher TR grades (2.4 ± 0.8 vs. 1.4 ± 0.6, < 0.001) and sPAP (51 ± 16 vs. 44 ± 12 mmHg, < 0.001). At 5-year post-surgery, RMA with TAP demonstrated higher freedom from recurrence or progression of TR (91 ± 3% vs. 81 ± 4%, log-rank = 0.036), yielding nearly identical sPAP (42 ± 18 vs. 40 ± 16 mmHg, = 0.54). Multivariable analysis demonstrated concomitant TAP was independently associated with freedom from significant recurrence in TR. Overall survival were not different between the groups ( = 0.74).
In patients with ischemic cardiomyopathy, concomitant TAP did not increase operative mortality and better reduced TR, resulting in comparable PH severity and long-term survival, compared to RMA alone.
我们阐明了在接受限制性二尖瓣成形术（RMA）的缺血性心肌病患者中，同期三尖瓣成形术（TAP）对术后三尖瓣反流（TR）、肺动脉高压（PH）和生存率的影响。
本研究纳入了234例接受RMA的缺血性心肌病患者（左心室射血分数≤40%）。其中，114例（49%）因继发性TR接受了同期TAP。主要终点是TR无明显复发（即中度或更严重）和进展（≥2+级）。次要终点是术后肺动脉收缩压（sPAP）和总生存率。
尽管TAP组的欧洲心脏手术风险评估系统（EuroSCORE）II评分较高（中位数，9.3%对7.2%，P = 0.016），但30天死亡率无差异（0.9%对0.8%，P = 0.97）。基线时，TAP组的TR分级更高（2.4±0.8对1.4±0.6，P<0.001），sPAP也更高（51±16对44±12 mmHg，P<0.001）。术后5年，RMA联合TAP显示TR复发或进展的自由度更高（91±3%对81±4%，对数秩检验P = 0.036），sPAP几乎相同（42±18对40±16 mmHg，P = 0.54）。多变量分析表明，同期TAP与TR无明显复发独立相关。两组的总生存率无差异（P = 0.74）。
在缺血性心肌病患者中，与单独的RMA相比，同期TAP不会增加手术死亡率，能更好地减少TR，导致PH严重程度和长期生存率相当。
