Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE

被引：13

作者：

Dreyfus, Julien ^{[1
]}

Juarez-Casso, Fernando ^{[2
]}

Sala, Alessandra ^{[3
]}

Carnero-Alcazar, Manuel ^{[4
]}

Eixeres-Esteve, Andrea ^{[5
]}

Bohbot, Yohann ^{[6
,7
]}

Bazire, Baptiste ^{[1
]}

Flagiello, Michele ^{[8
]}

Riant, Elisabeth ^{[1
]}

Mbaki, Yannick ^{[9
]}

Tomasi, Jacques ^{[10
]}

Senage, Thomas ^{[11
]}

Rahmouni El Idrissi, Kenza ^{[12
]}

Coisne, Augustin ^{[13
,14
]}

Eyharts, Damien ^{[15
]}

Doguet, Fabien ^{[16
]}

Viau, Florence ^{[17
]}

Eggenspieler, Florian ^{[18
]}

Heuts, Samuel ^{[19
,20
]}

Sardari Nia, Peyman ^{[19
,20
]}

Heitzinger, Gregor ^{[21
]}

Galloo, Xavier ^{[22
,23
]}

Ajmone Marsan, Nina ^{[22
]}

Benfari, Giovanni ^{[24
,25
]}

Badano, Luigi ^{[26
,27
]}

Muraru, Denisa ^{[26
,27
]}

Maisano, Francesco ^{[28
]}

Topilsky, Yan ^{[29
]}

Michelena, Hector ^{[24
]}

Enriquez-Sarano, Maurice ^{[30
]}

Bax, Jeroen ^{[22
]}

Bartko, Philipp ^{[21
]}

Selton-Suty, Christine ^{[18
]}

Habib, Gilbert ^{[17
]}

Lavie-Badie, Yoan ^{[15
]}

Modine, Thomas ^{[31
]}

Chan, Vincent ^{[12
]}

Le Tourneau, Thierry ^{[32
]}

Donal, Erwan ^{[9
]}

Lim, Pascal ^{[33
]}

Radu, Costin ^{[34
]}

Bernick, Jordan ^{[35
]}

Wells, George A. ^{[35
]}

Tribouilloy, Christophe ^{[6
,7
]}

Iung, Bernard ^{[36
,37
]}

Obadia, Jean-Francois ^{[8
]}

De Bonis, Michele ^{[3
]}

Crestanello, Juan ^{[2
]}

Messika-Zeitoun, David ^{[38
]}

机构：

[1] Ctr Cardiol Nord, Dept Cardiol, 32-36 Rue Moulins Gemeaux, F-93200 St Denis, France

[2] Mayo Clin, Dept Cardiovasc Surg, Rochester, MN USA

[3] Univ Vita Salute San Raffaele, IRCCS San Raffaele Sci Inst, Dept Cardiac Surg, Milan, Italy

[4] Hosp Clin San Carlos, Dept Cardiac Surg, Madrid, Spain

[5] Hosp 12 Octubre, Cardiac Surg Dept, Madrid, Spain

[6] Amiens Univ Hosp, Dept Cardiol, Amiens, France

[7] Jules Verne Univ Picardie, UR UPJV 7517, Amiens, France

[8] Claude Bernard Univ, Louis Pradel Cardiovasc Hosp, Dept Cardiovasc Surg & Transplantat, Bron, France

[9] Univ Rennes 1, Cardiol Dept, LTSI UMR1099, INSERM,CHU RENNES, Rennes, France

[10] Univ Rennes 1, Dept Cardiac Surg, CHU RENNES, Rennes, France

[11] Univ Nantes, Dept Cardiac Surg, INSERM 1246, CHU Nantes, Nantes, France

[12] Univ Ottawa, Heart Inst, Div Cardiac Surg, Ottawa, ON, Canada

[13] CHU Lille, Dept Clin Physiol & Echocardiog, Heart Valve Clin, Lille, France

[14] Univ Lille, Inserm, CHU Lille, Inst Pasteur Lille, Lille, France

[15] Toulouse Univ Hosp, Heart Valve Ctr, Toulouse, France

[16] CHU Charles Nicolle, Dept Cardiol & Cardiovasc Surg, Rouen, France

[17] La Timone Hosp, Cardiol Dept, APHM, Marseille, France

[18] CHU Nancy Brabois, Cardiol Dept, Nancy, France

[19] Maastricht Univ Med Ctr MUMC, Dept Cardiothorac Surg, Maastricht, Netherlands

[20] Univ Maastricht, Cardiovasc Res Inst Maastricht CARIM, Maastricht, Netherlands

[21] Med Univ Vienna, Dept Internal Med 2, Cardiol, Vienna, Austria

[22] Leiden Univ, Med Ctr, Dept Cardiol, Leiden, Netherlands

[23] Free Univ Brussels VUB, Univ Hosp Brussels UZ Brussel, Dept Cardiol, Brussels, Belgium

[24] Mayo Clin, Cardiovasc Dis Dept, Rochester, MN USA

[25] Univ Verona, Dept Med, Sect Cardiol, Verona, Italy

[26] IRCCS, Ist Auxol Italiano, Dept Cardiol, Milan, Italy

[27] Univ Milano Bicocca, Dept Med & Surg, Milan, Italy

[28] Univ Vita Salute, Osped San Raffaele, Cardiac Surg & Heart Valve Ctr, Milan, Italy

[29] Sackler Fac Med, Tel Aviv Med Ctr, Dept Cardiol, Tel Aviv, Israel

[30] Minneapolis Heart Inst, Valve Sci Ctr, Minneapolis, MN USA

[31] Bordeaux Univ Hosp, Hop Cardiol Haut Leveque, Dept Cardiol & Cardiovasc Surg, Bordeaux, France

[32] Univ Nantes, CHU Nantes, CNRS, INSERM,Inst Thorax, Nantes, France

[33] Henri Mondor Hosp, Expert Valve Ctr, Cardiol Dept, Creteil, France

[34] Henri Mondor Univ Hosp, AP HP, Dept Cardiac Surg, Creteil, France

[35] Univ Ottawa, Heart Inst, Cardiovasc Res Methods Ctr, Ottawa, ON, Canada

[36] Univ Paris, Bichat Hosp, Cardiol Dept, APHP, Paris, France

[37] Univ Paris, INSERM, LVTS, U1148, Paris, France

[38] Univ Ottawa, Heart Inst, Div Cardiol, 40 Ruskin St, Ottawa, ON K1Y 4W7, Canada

来源：

EUROPEAN HEART JOURNAL | 2024年 / 45卷 / 42期

关键词：

Tricuspid regurgitation; Surgery; Management; Outcome; ASSOCIATION; IMPACT;

D O I：

10.1093/eurheartj/ehae578

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Background and Aims Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery. Methods In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: <= 3, intermediate: 4-5, and high: >= 6). Results One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88-1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20-.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98-1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91-1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06-.19, P < .0001, and HR .65; 95% CI .47-.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35-.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P = .0002). Conclusions Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.

引用

页码：4512 / 4522

页数：11

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