带支架生物瓣膜与二尖瓣同种异体移植在三尖瓣感染性心内膜炎外科治疗中的比较

Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis.

作者信息

Nuzhdin Mikhail, Malinovsky Yury, Galchenko Maksim, Komarov Roman, Fokin Aleksey, Nadtochiy Nikita

机构信息

Department of Cardiac Surgery, State Budgetary Healthcare Institution "Chelyabinsk Regional Clinical Hospital", 454048 Chelyabinsk, Russian Federation.

Department of Surgery, South Ural State Medical University, 454092 Chelyabinsk, Russian Federation.

出版信息

Rev Cardiovasc Med. 2025 Jul 8;26(7):37204. doi: 10.31083/RCM37204. eCollection 2025 Jul.

DOI:10.31083/RCM37204

PMID:40776959

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12326450/

Abstract

BACKGROUND

The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prostheses remain high. Allografts may represent a suitable alternative in tricuspid surgery. This study aimed to compare outcomes between stented biological valves and mitral allografts (MAs) for tricuspid valve replacement (TVR).

METHODS

A total of 54 patients with IE underwent TVR using either a stented bioprosthesis (B) or MA between January 2016 and July 2024. Clinical and echocardiographic data were analyzed in accordance with the Tricuspid-Valve Academic Research Consortium (T-VARC) criteria. Early safety, clinical efficacy, and time-to-event survival were compared between the two equal B and MA groups.

RESULTS

There were no in-hospital or 30-day mortality, nor cardiac, cerebral, and wound complications in either group. The peak and mean pressure gradient (PG) on TV after surgery were 9.2 (6.5-12.0) and 4.0 (3.2-6.0) mmHg in the B group versus 6.0 (4.5-7.5) and 3.0 (2.0-4.0) mmHg in the MA group ( < 0.001). A T-VARC-adjusted analysis demonstrated superior freedom from cardiovascular mortality, recurrent IE, reoperation, and permanent pacemaker implantation (PPI) in the MA group 2 years after operation. Kaplan-Meier analysis revealed significantly higher freedom from cardiovascular mortality in the MA group (100% vs. 81.5%, 77.8%, 77.8%, 69.6% respectively (log-rank test, = 0.011) at 12-, 18-, 24-, 36-months, and freedom from PPI (100% vs. 81% at all time intervals) (log-rank test, = 0.021).

CONCLUSION

Application of contemporary endpoint criteria demonstrated superior outcomes with MA, including lower cardiovascular mortality, reduced PPI, fewer recurrent endocarditis, decreased reoperations, cardiac hospitalizations, alongside improved patient-reported outcomes. Time-to-event analysis demonstrated benefits in cardiovascular survival and PPI avoidance with allografts. Mitral allograft may be a preferable alternative valve substitute for TVR in patients with IE.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT06591000, https://clinicaltrials.gov/study/NCT06591000?term=NCT06591000&rank=1, registration date: September 19, 2024.

摘要

背景

在药物成瘾、慢性血管通路或心脏电子设备患者中，三尖瓣（TV）感染性心内膜炎（IE）的患病率持续上升。此外，使用传统人工瓣膜进行手术后的长期死亡率和发病率仍然很高。同种异体移植物可能是三尖瓣手术的合适替代方案。本研究旨在比较带支架生物瓣膜与二尖瓣同种异体移植物（MAs）用于三尖瓣置换术（TVR）的疗效。

方法

2016年1月至2024年7月期间，共有54例IE患者接受了TVR，使用的是带支架生物假体（B）或MA。根据三尖瓣学术研究联盟（T-VARC）标准对临床和超声心动图数据进行分析。比较了两个相等的B组和MA组之间的早期安全性、临床疗效和事件发生时间生存率。

结果

两组均无院内或30天死亡率，也无心脏、脑和伤口并发症。B组术后TV上的峰值和平均压力梯度（PG）分别为9.2（6.5-12.0）和4.0（3.2-6.0）mmHg，而MA组为6.0（4.5-7.5）和3.0（2.0-4.0）mmHg（<0.001）。经T-VARC调整的分析表明，术后2年MA组在心血管死亡率、复发性IE、再次手术和永久性起搏器植入（PPI）方面具有更好的自由度。Kaplan-Meier分析显示，MA组在心血管死亡率方面的自由度显著更高（12个月、18个月、24个月、36个月时分别为100%对81.5%、77.8%、77.8%、69.6%（对数秩检验，=0.011）），在PPI方面的自由度也更高（所有时间间隔均为100%对81%）（对数秩检验，=0.0