International journal of cardiology · 2025
Long-term outcomes of tricuspid valve plasty vs. replacement after cardiac surgery: Mortality, reoperation, and anticoagulation complications in patients with postoperative tricuspid regurgitation.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Hua Linbin, Pang Shanwen, Zhang Zhaolong, Chen Jing, Qiu Junqiang, Wang Qiuji, Wang Zhenzhong, Zhong Lishan, Ke Yingjie, Huang Huanlei
Аннотация
BACKGROUND: This study compared long-term outcomes of tricuspid valve plasty (TVP) versus tricuspid valve replacement (TVR) in patients with severe tricuspid regurgitation (TR) undergoing redo cardiac surgery, focusing on survival, reoperation, and anticoagulation-related complications.
METHODS: We performed a single-center retrospective cohort study of consecutive patients treated from 1999 to 2024 (n = 393; TVP = 142; TVR = 251, including 54 mechanical and 197 bioprosthetic valves). Propensity score matching (1:1) was applied to balance key baseline variables for TVR versus TVP (n = 176; 88/88) and for bioprosthetic TVR (BTVR) versus TVP (n = 166; 83/83).
RESULTS: In propensity score-matched groups, median follow-up was 7.97 years. After matching, TVP was associated with shorter ventilation (17 vs 22 h; P = 0.016) and hospital stay (7 vs 11 days; P < 0.001) compared to TVR. Thirty-day mortality was lower with TVP versus BTVR (3.4 % vs 8.0 %; P = 0.040). Anticoagulation-related bleeding was more frequent after TVR (7.95 % vs 0 %; P = 0.021). Reoperation rates were lower with TVP (0 % vs 5.7 %; P = 0.072). Five-year survival was 82.8 % for TVP and 75.6 % for TVR.
CONCLUSIONS: In patients with severe TR undergoing redo cardiac surgery, TVP yielded faster early recovery, fewer bleeding complications, and a numerically lower reoperation rate without compromising long-term survival. These findings support a repair-first strategy when anatomy is suitable, particularly in patients at elevated bleeding risk.
METHODS: We performed a single-center retrospective cohort study of consecutive patients treated from 1999 to 2024 (n = 393; TVP = 142; TVR = 251, including 54 mechanical and 197 bioprosthetic valves). Propensity score matching (1:1) was applied to balance key baseline variables for TVR versus TVP (n = 176; 88/88) and for bioprosthetic TVR (BTVR) versus TVP (n = 166; 83/83).
RESULTS: In propensity score-matched groups, median follow-up was 7.97 years. After matching, TVP was associated with shorter ventilation (17 vs 22 h; P = 0.016) and hospital stay (7 vs 11 days; P < 0.001) compared to TVR. Thirty-day mortality was lower with TVP versus BTVR (3.4 % vs 8.0 %; P = 0.040). Anticoagulation-related bleeding was more frequent after TVR (7.95 % vs 0 %; P = 0.021). Reoperation rates were lower with TVP (0 % vs 5.7 %; P = 0.072). Five-year survival was 82.8 % for TVP and 75.6 % for TVR.
CONCLUSIONS: In patients with severe TR undergoing redo cardiac surgery, TVP yielded faster early recovery, fewer bleeding complications, and a numerically lower reoperation rate without compromising long-term survival. These findings support a repair-first strategy when anatomy is suitable, particularly in patients at elevated bleeding risk.