AIM To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODS One hundred and eighty patients(68 ± 12 years,...AIM To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODS One hundred and eighty patients(68 ± 12 years,79 males) underwent tricuspid annuoplasty.Cox proportionalhazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.RESULTS Tricuspid regurgitation etiology was functional in 154 cases(86%),organic in 16 cases(9%),and mixed in10 cases(6%),respectively.Postoperative mortality at 30 days was 11.7%.Mean follow-up was 51.7 mo with survival at 5 years of 73.5%.Risk factors for mortality were acute endocarditis [hazard ratio(HR) = 9.22(95%CI:2.87-29.62),P < 0.001],ischemic heart disease requiring myocardial revascularization [HR = 2.79(1.26-6.20),P = 0.012],and aortic valve stenosis [HR = 2.6(1.15-5.85),P = 0.021].Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21(1.11-4.39),P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98(1.04-3.92),P = 0.044].However,successful mitral valve repair showed a protective effect [HR = 0.32(0.10-0.98),P = 0.046].Additionally,in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair,mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs.The explanation may lie in the fact that significant tricuspid regurgitation following leftsided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.CONCLUSION Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation,although it usually reveals an overly delayed correction of a left-sided heart disease.展开更多
文摘AIM To determine whether the need for additional tricuspid valve repair is an independent risk factor when surgery is required for a left-sided heart disease.METHODS One hundred and eighty patients(68 ± 12 years,79 males) underwent tricuspid annuoplasty.Cox proportionalhazards regression model for multivariate analysis was performed for variables found significant in univariate analyses.RESULTS Tricuspid regurgitation etiology was functional in 154 cases(86%),organic in 16 cases(9%),and mixed in10 cases(6%),respectively.Postoperative mortality at 30 days was 11.7%.Mean follow-up was 51.7 mo with survival at 5 years of 73.5%.Risk factors for mortality were acute endocarditis [hazard ratio(HR) = 9.22(95%CI:2.87-29.62),P < 0.001],ischemic heart disease requiring myocardial revascularization [HR = 2.79(1.26-6.20),P = 0.012],and aortic valve stenosis [HR = 2.6(1.15-5.85),P = 0.021].Significant predictive factors from univariate analyses were double-valve replacement combined with tricuspid annuloplasty [HR = 2.21(1.11-4.39),P = 0.003] and preoperatively impaired ejection fraction [HR = 1.98(1.04-3.92),P = 0.044].However,successful mitral valve repair showed a protective effect [HR = 0.32(0.10-0.98),P = 0.046].Additionally,in instances where tricuspid regurgitation required the need for concomitant tricuspid valve repair,mortality predictor scores such as Euroscore 2 could be shortened to a simple Euroscore-tricuspid comprised of only 7 inputs.The explanation may lie in the fact that significant tricuspid regurgitation following leftsided heart disease represents an independent risk factor encompassing several other factors such as pulmonary arterial hypertension and dyspnea.CONCLUSION Tricuspid annuloplasty should be used more often as a concomitant procedure in the presence of relevant tricuspid regurgitation,although it usually reveals an overly delayed correction of a left-sided heart disease.
