Long-term outcomes after bioprosthetic tricuspid valve replacement: a multicenter study.

IF 3 2区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

European Journal of Cardio-Thoracic Surgery Pub Date : 2025-03-28 DOI:10.1093/ejcts/ezaf107

Antonio Piperata, Jef Van den Eynde, Mateo Marin-Cuartas, Giacomo Bortolussi, Petr Fila, Tim Walter, Mehmet Cahit Sarıcaoğlu, Jan Gofus, Bilkhu Rajdeep, Michel Pompeu Sá, Fabrizio Rosati, Manuela De la Cuesta, Elisa Gastino, Besart Cuko, Julien Ternacle, Carlo de Vincentiis, Martin Czerny, Ahmet Rüçhan Akar, Gianluca Lucchese, Basel Ramlawi, Michael A Borger, Thomas Modine

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引用次数: 0

Abstract

Objectives: Long-term evidence about bioprosthetic tricuspid valve replacement is scarce. This study aims to investigate the long-term clinical outcomes of patients who underwent tricuspid valve replacement with bioprostheses.

Methods: This multicentre retrospective study included patients from 10 high-volume centres in 7 different countries, who underwent tricuspid valve replacement with bioprostheses. Echocardiographic and clinical data were reviewed. Long-term outcomes were investigated using Kaplan-Meier estimates, Cox regression, and competing risk analysis.

Results: Of 675 patients, isolated tricuspid valve replacement was performed in 358 patients (53%), while 317 (47%) underwent concomitant procedures. Between these 2 groups, patients who underwent combined procedures reported a significantly higher incidence of infection, atrioventricular block, multi-organ failure, longer intensive care unit and hospital stay and higher 30-day mortality over patients who underwent isolated procedure. The overall 30-day mortality occurred in 70 patients (10.4%) [46 (14.6%) combined vs 24 (6.74%) isolated, P = 0.001]. During the follow-up, there was a continuous rate of attrition due to death, with cumulative incidences of death at 5, 10 and 15 years being 27.2%, 46.2% and 60.6%, respectively. In contrast, the risk of reintervention starts to significantly increase after 10 years of follow-up, with cumulative incidences of reintervention being 6.1%, 10.8% and 23.3%, respectively. Freedom from tricuspid valve reintervention, pacemaker implantation, tricuspid valve endocarditis and major thromboembolic events at 15 years were 56.5%, 77.3%, 84.0% and 86.4%, respectively.

Conclusions: Tricuspid valve replacement with bioprostheses is an effective treatment for valvular disease, despite being associated with relatively high early and long-term mortality. However, the risk of structural valve degeneration rises significantly after 10 years.

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生物假体三尖瓣置换术后的长期疗效：一项多中心研究。

目的：关于生物假体三尖瓣置换术的长期证据很少。本研究旨在探讨生物假体置换三尖瓣患者的长期临床结果。方法：这项多中心回顾性研究包括来自7个不同国家的10个大容量中心的患者，他们接受了生物假体三尖瓣置换术。回顾超声心动图和临床资料。使用Kaplan-Meier估计、Cox回归和竞争风险分析对长期结果进行调查。结果：在675例患者中，358例（53%）患者接受了孤立三尖瓣置换术，317例（47%）患者接受了伴随手术。在这两组中，与单独手术的患者相比，接受联合手术的患者感染、房室传导阻滞、多器官功能衰竭、ICU和住院时间更长、30天死亡率更高。总30天死亡率为70例（10.4%）[联合组46例（14.6%）Vs单独组24例（6.74%），p = 0.001]。在随访期间，由于死亡导致的持续损耗率，5年、10年和15年的累积死亡率分别为27.2%、46.2%和60.6%。而再干预风险在随访10年后开始显著增加，累计再干预发生率分别为6.1%、10.8%和23.3%。15年无三尖瓣再介入、起搏器植入、三尖瓣心内膜炎和主要血栓栓塞事件分别为56.5%、77.3%、84.0%和86.4%。结论：生物假体置换三尖瓣是一种有效的治疗瓣膜疾病的方法，尽管与相对较高的早期和长期死亡率相关。然而，结构性瓣膜退化的风险在10年后显著上升。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Cardio-Thoracic Surgery 医学-呼吸系统

CiteScore

5.60

自引率

11.80%

发文量

564

审稿时长

2 months

期刊介绍： The primary aim of the European Journal of Cardio-Thoracic Surgery is to provide a medium for the publication of high-quality original scientific reports documenting progress in cardiac and thoracic surgery. The journal publishes reports of significant clinical and experimental advances related to surgery of the heart, the great vessels and the chest. The European Journal of Cardio-Thoracic Surgery is an international journal and accepts submissions from all regions. The journal is supported by a number of leading European societies.