Seo-Yeon Gwak, Kyu Kim, Hyun-Jung Lee, Iksung Cho, Geu-Ru Hong, Jong-Won Ha, Chi Young Shim
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引用次数: 0
Abstract
Background: In patients with tricuspid regurgitation (TR), delayed surgical intervention is associated with poor outcomes, particularly in advanced stages. This study aimed to assess whether earlier tricuspid valve (TV) surgery provides a survival benefit in patients with moderate to severe TR who are considered at low to intermediate risk of adverse clinical or surgical outcomes.
Methods: This retrospective cohort study included 10 016 patients diagnosed with moderate to severe TR between 2008 and 2020. Patients were stratified using the the Tricuspid Regurgitation Impact on Outcomes (TRIO) Score (for general health risk) and TRI-SCORE (for perioperative risk). We focused on patients deemed at low or intermediate risk by these scores, comparing the all-cause mortality of those who underwent TV surgery to those managed medically.
Results: Among 8874 patients categorised as low or intermediate risk, 871 (9.8%) underwent TV surgery. Patients in the surgical group were younger and had a higher prevalence of RV enlargement and RV dysfunction compared to those in the medical treatment group. During a mean follow-up of 5.2 years, surgical patients had a lower risk of death (HR 0.38, 95% CI 0.29 to 0.50) compared with medically managed patients after adjusting for confounders. This association persisted in patients who underwent isolated TV surgery. However, the potential for residual confounding in this non-randomised analysis should be considered.
Conclusions: TV surgery was associated with higher survival rates in patients with moderate to severe TR and low to intermediate prognostic risk. However, the observational nature of the study means that uncontrolled confounding cannot be excluded. These findings warrant further investigation in randomised studies.
背景:在三尖瓣反流(TR)患者中,延迟手术干预与不良预后相关,特别是在晚期。本研究旨在评估早期三尖瓣(TV)手术是否能为中度至重度TR患者提供生存益处,这些患者被认为具有低至中等的不良临床或手术结果风险。方法:本回顾性队列研究纳入2008年至2020年间诊断为中重度TR的10016例患者。使用三尖瓣反流对预后影响评分(TRIO)(一般健康风险)和TRI-SCORE(围手术期风险)对患者进行分层。我们将重点放在这些评分被认为是低或中等风险的患者身上,比较那些接受电视手术的患者和那些接受医学治疗的患者的全因死亡率。结果:在8874例低或中危患者中,871例(9.8%)接受了电视手术。与内科治疗组相比,手术组患者更年轻,右心室扩大和右心室功能障碍的发生率更高。在平均5.2年的随访期间,在调整混杂因素后,手术患者的死亡风险较医学治疗患者低(HR 0.38, 95% CI 0.29至0.50)。这种关联在接受孤立电视手术的患者中持续存在。然而,在这种非随机分析中,应该考虑到残留混淆的可能性。结论:电视手术与中重度TR和中低预后风险患者较高的生存率相关。然而,该研究的观察性质意味着不能排除非控制的混杂因素。这些发现值得在随机研究中进一步调查。
期刊介绍:
Heart is an international peer reviewed journal that keeps cardiologists up to date with important research advances in cardiovascular disease. New scientific developments are highlighted in editorials and put in context with concise review articles. There is one free Editor’s Choice article in each issue, with open access options available to authors for all articles. Education in Heart articles provide a comprehensive, continuously updated, cardiology curriculum.