Hage Ali, Blackstone Eugene H, Malas Tarek, Svensson Lars G, Lowry Ashley M, Bernabei Annalisa, McCurry Kenneth, Elgharably Haytham, Gillinov Marc
Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
Department of Quantitative Health Sciences, Research Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
JTCVS Open. 2025 Apr 11;25:72-84. doi: 10.1016/j.xjon.2025.03.025. eCollection 2025 Jun.
To trace the temporal trajectory of unrepaired moderate tricuspid regurgitation (TR) after primary, isolated mitral valve repair (MVr) alone compared with none or mild TR, and to determine whether moderate TR is associated with worse survival.
Between January 1, 2000, and December 21, 2022, a total of 5467 consecutive patients (mean age, 58 ±12 years) with severe degenerative mitral regurgitation (MR) underwent MVr alone without concomitant TR repair. Of these, 3418 (63%) had no TR, 1652 (30%) had mild TR, and 397 (7%) had moderate TR. They were followed prospectively for a maximum duration of 24 years.
Patients with preoperative moderate TR had an increased unadjusted risk of mortality (70% survival) at 14 years compared to patients with mild TR (81% survival) and those with no TR (85% survival), mostly related to a higher baseline risk profile. Patients who died during follow-up were more likely to have moderate TR compared to those who survived. Among patients with unaddressed moderate preoperative TR, the proportion with persistent moderate TR dropped to 19% (from 100%) immediately after MVr and then increased to 31% at 10 years. Degree of preoperative TR and postoperative MR were associated with moderate or greater TR during follow-up.
Patients with untreated preoperative moderate TR undergoing isolated MV surgery had incomplete resolution of their TR. The presence of moderate TR during follow-up was associated with increased mortality at long-term follow-up, mostly related to a higher baseline risk profile. MR perhaps should be treated before the development of moderate TR.
追踪单纯初次孤立性二尖瓣修复术（MVr）后未修复的中度三尖瓣反流（TR）与无或轻度TR相比的时间轨迹，并确定中度TR是否与较差的生存率相关。
在2000年1月1日至2022年12月21日期间，共有5467例连续的严重退行性二尖瓣反流（MR）患者（平均年龄58±12岁）接受了单纯MVr，未同时进行TR修复。其中，3418例（63%）无TR，1652例（30%）有轻度TR，397例（7%）有中度TR。对他们进行了最长24年的前瞻性随访。
术前中度TR患者在14年时的未调整死亡风险增加（生存率70%），而轻度TR患者（生存率81%）和无TR患者（生存率85%）则不然，这主要与更高的基线风险特征有关。与存活患者相比，随访期间死亡的患者更有可能有中度TR。在术前未处理的中度TR患者中，持续中度TR的比例在MVr后立即从100%降至19%，然后在10年时升至31%。术前TR程度和术后MR与随访期间中度或更严重的TR相关。
接受孤立MV手术的术前未治疗的中度TR患者的TR未完全缓解。随访期间中度TR的存在与长期随访时死亡率增加相关，这主要与更高的基线风险特征有关。也许应该在中度TR发展之前治疗MR。
