Long-term Prognostic Analysis of Re-operation in Patients With Functional Tricuspid Regurgitation After Left-sided Valve Replacement
10.3969/j.issn.1000-3614.2016.04.015
- VernacularTitle:左心瓣膜替换术后三尖瓣功能性关闭不全患者外科再次手术的远期预后分析
- Author:
Minghui TONG
;
Yi SHI
;
Shen LIU
;
Xiang LUO
;
Chao DONG
;
Yan YANG
;
Wei WANG
;
Jianping XU
- Publication Type:Journal Article
- Keywords:
Tricuspid valve insufifciency;
Heart valve implantation,artiifcial;
Ventricular dysfunction,right
- From:
Chinese Circulation Journal
2016;31(4):376-380
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To analyze the long-term prognosis of re-operation in patients with functional tricuspid regurgitation (FTR) after left sided valve replacement (LSVR) and hence evaluate the optimal timing of mentioned re-operation. Methods: A total of 59 FTR patients who had re-operation after their prior LSVR in our hospital from 1999-01 to 2013-01 were analyzed. The clinical information and post-operative follow-up results were recorded in all patients. Results: There were 5/59 (8.5%) patients died in peri-operative period and the overall post-operative mortality was 11.9% (7/59). The follow-up data of 54 survivors were available for the mean time of 51.1 (21-188) months. There were 19/54 (35.2%) patients suffered from MACE and 30 (55.6%) were beneifted by improved cardiac function. Uni-variable analysis indicated that pre-operative NYHA class IV (P=0.008), pre-operative right ventricular (RV) dysfunction (P=0.037), concomitant left-sided redo-operation (P=0.017) and TVR operation (P=0.002) were associated with all cause mortality of tricuspid re-operation. Multi-variable Cox regression analysis showed that pre-operative RV dysfunction was the only independent risk factor of long term MACE-free accumulating survival rate (HR=3.0, 95% CI 1.11-8.2,P=0.031); while TVR operation (HR=12.8, 95% CI 1.53-107.02,P=0.019) and pre-operative NYHA class IV (HR=5.3, 95% CI 1.20-24.51,P=0.032) were the independent risk factors for long-term mortality in patients after tricuspid re-operation. Conclusion: Patients with compensatory RV function showed better long term prognosis after secondary tricuspid operation. Aggressive re-operation before the occurrence of right ventricular dysfunction could be beneficial for relevant patients.
