Circulation journal : official journal of the Japanese Circulation Society · 2015
Late outcome of tricuspid annuloplasty using a flexible band/ring for functional tricuspid regurgitation.
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Fukunaga Naoto, Okada Yukikatsu, Konishi Yasunobu, Murashita Takashi, Koyama Tadaaki
Аннотация
BACKGROUND: We assessed late outcome after tricuspid annuloplasty (TAP) using a flexible band or ring for functional tricuspid regurgitation (FTR).
METHODS AND RESULTS: We reviewed 220 consecutive patients (mean age, 65.4±11.4 years) who underwent TAP for FTR during mitral valve surgery between January 2000 and December 2010. Indications for TAP included the following: (1) TR grade greater than mild; (2) history of right heart failure; (3) atrial fibrillation; and (4) systolic pulmonary artery pressure (SPAP) ≥50 mmHg. The mean follow-up period was 4.4±2.6 years. Overall hospital mortality was 5.5% (12/220). The 5- and 10-year survival rates were 90.2±2.1% and 82.4±5.6%, respectively. Freedom from recurrent TR at 8 years was 78.0±6.6%. Twenty patients had a greater than mild TR grade at final follow-up. Elevated SPAP was a predictor of recurrent TR (hazard ratio, 1.091; P=0.0003), which was associated with advanced age, atrial fibrillation, rheumatic etiology and preoperative TR grade. There was a significant difference in freedom from valve-related events between residual TR greater than mild and less than moderate (log-rank test, P=0.0464). Factors affecting residual TR were preoperative TR grade (OR, 7.368; P=0.0267) and mitral valve replacement (OR, 4.369; P=0.0402).
CONCLUSIONS: Late outcome of TAP in the present series was acceptable. Late outcome can be improved by performing TAP before deterioration of TR.
METHODS AND RESULTS: We reviewed 220 consecutive patients (mean age, 65.4±11.4 years) who underwent TAP for FTR during mitral valve surgery between January 2000 and December 2010. Indications for TAP included the following: (1) TR grade greater than mild; (2) history of right heart failure; (3) atrial fibrillation; and (4) systolic pulmonary artery pressure (SPAP) ≥50 mmHg. The mean follow-up period was 4.4±2.6 years. Overall hospital mortality was 5.5% (12/220). The 5- and 10-year survival rates were 90.2±2.1% and 82.4±5.6%, respectively. Freedom from recurrent TR at 8 years was 78.0±6.6%. Twenty patients had a greater than mild TR grade at final follow-up. Elevated SPAP was a predictor of recurrent TR (hazard ratio, 1.091; P=0.0003), which was associated with advanced age, atrial fibrillation, rheumatic etiology and preoperative TR grade. There was a significant difference in freedom from valve-related events between residual TR greater than mild and less than moderate (log-rank test, P=0.0464). Factors affecting residual TR were preoperative TR grade (OR, 7.368; P=0.0267) and mitral valve replacement (OR, 4.369; P=0.0402).
CONCLUSIONS: Late outcome of TAP in the present series was acceptable. Late outcome can be improved by performing TAP before deterioration of TR.
Предметные рубрики MeSH
Age FactorsAgedAtrial FibrillationCardiac Valve AnnuloplastyComorbidityFemaleFollow-Up StudiesHeart Valve Prosthesis ImplantationHospital MortalityHumansHypertension, PulmonaryKaplan-Meier EstimateMaleMiddle AgedMitral Valve InsufficiencyPacemaker, ArtificialPostoperative ComplicationsPrognosisProstheses and ImplantsRecurrenceRetrospective StudiesRheumatic Heart DiseaseRisk FactorsTreatment OutcomeTricuspid Valve InsufficiencyUltrasonography