Van Nooten G J, Caes F, Taeymans Y, Van Belleghem Y, François K, De Bacquer D, Deuvaert F E, Wellens F, Primo G
Department of Surgery, University Hospital of Ghent, Belgium.
J Thorac Cardiovasc Surg. 1995 Sep;110(3):672-9. doi: 10.1016/S0022-5223(95)70098-6.
A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rates (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.012), and New York Heart Association functional class IV (p = 0.013). Multivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The hospital survivors were followed up for a median of 94 months. A complete follow-up was available for all patients except two for 30 months or more. At 30 months the only two significant parameters were the type of myocardial protection (p = 0.024) and the year of operation (before 1977 or after [precardioplegia era or after], p = 0.011). There were 70 late deaths during the entire follow-up period. The univariate (log-rank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St. Jude Medical versus bioprosthesis) (p = 0.04). A trend was observed for the type of operative myocardial protection (normothermia and coronary perfusion) (p = 0.06) and preoperative New York Heart Association functional class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23.4% at 180 months. Cumulative follow-up added up to 1015 patient-years. In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between the bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the bileaflet valves (p = 0.15). When the follow-up period was stratified according to less than 7 years and more than 7 years of follow-up, no difference was observed for the first period, but for the late follow-up the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years and favoring mechanical prostheses for those patients with a good long-term prognosis.
回顾了1967年至1987年间在布鲁格曼大学医院接受三尖瓣置换术的146例连续患者。手术时的平均年龄为51.4岁（±12.1岁）。植入了不同类型的假体，包括猪和牛心包生物假体以及较旧的和双叶机械瓣膜。大多数患者术前因心脏病而严重致残，纽约心脏协会功能分级III级的占30.1%，IV级的占69.9%。手术死亡率和医院死亡率（30天）很高（16.4%）。医院死亡的增量危险因素包括黄疸（p<0.005）、术前肝肿大（p = 0.012）和纽约心脏协会功能分级IV级（p = 0.013）。多变量分析仅选择术前黄疸（p<0.01）与医院死亡率独立显著相关。医院幸存者的中位随访时间为94个月。除两名患者外，所有患者均有30个月或更长时间的完整随访。在30个月时，仅有的两个显著参数是心肌保护类型（p = 0.024）和手术年份（1977年之前或之后[心脏停搏前时代或之后]，p = 0.011）。在整个随访期间有70例晚期死亡。晚期死亡的单变量（对数秩统计）增量危险因素是三尖瓣假体类型（斯梅洛夫-卡特和凯-希利型与圣犹达医疗型与生物假体）（p = 0.04）。观察到手术心肌保护类型（常温与冠状动脉灌注）（p = 0.06）和术前纽约心脏协会功能分级IV级（p = 0.055）有趋势性差异。60个月时的精算生存率为74%，180个月时为23.4%。累积随访总计1015患者年。在对三尖瓣假体类型对生存的影响进行更详细分析时，观察到生物假体与一些较旧的机械假体（斯梅洛夫-卡特和凯-希利型）之间存在显著差异（p = 0.04），但生物假体与双叶瓣膜之间无差异（p = 0.15）。当根据随访期少于7年和多于7年进行分层时，第一阶段未观察到差异，但在晚期随访中，新型机械假体比生物假体表现更好（p = 0.05），这表明生物假体在7年后会退化，对于那些长期预后良好的患者，机械假体更具优势。
