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退行性二尖瓣反流患者同时施行三尖瓣修复术可显著改善患者预后
作者:小柯机器人 发布时间:2021/11/21 23:52:17

美国西奈山伊坎医学院Annetine C. Gelijns团队研究了退行性二尖瓣反流患者同时施行三尖瓣修复术对临床预后的影响。相关论文于2021年11月13日发表在《新英格兰医学杂志》上。

严重退行性二尖瓣反流患者常发生三尖瓣反流。然而,在二尖瓣手术中,对于中度三尖瓣反流或低中度反流伴环形扩张的患者,是否进行三尖瓣修复并没有足够的证据基础。

研究组招募了401名因退行性二尖瓣反流接受二尖瓣手术的患者,将其随机分配分别接受或不接受三尖瓣环成形术(TA)。主要的2年终点是三尖瓣反流再次手术、三尖瓣反流从基线检查时进展两级或出现严重三尖瓣反流或死亡。

与单独接受二尖瓣手术的患者相比,接受二尖瓣手术加TA的患者的主要终点事件较少(分别为3.9%对10.2%),相对风险为0.37。二尖瓣手术加TA组和单纯二尖瓣手术组的两年死亡率分别为3.2%和4.5%,相对风险为0.69。二尖瓣手术加TA组三尖瓣反流进展的2年患病率为0.6%,显著低于单纯二尖瓣手术组的6.1%,相对风险为0.09。治疗2年后,两组重大不良心脑血管事件、功能状态和生活质量的发生率相似,但二尖瓣手术加TA组永久性起搏器植入的发生率为14.1%,显著高于单纯手术组的2.5%。

研究结果表明,在接受二尖瓣手术的患者中,同时接受TA治疗后2年主要终点事件发生率低于单独二尖瓣手术的患者,降低原因是进展为严重三尖瓣反流的风险较低。三尖瓣修复导致更频繁的永久性起搏器植入。

附:英文原文

Title: Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation | NEJM

Author: James S. Gammie, M.D.,, Michael W.A. Chu, M.D.,, Volkmar Falk, M.D.,, Jessica R. Overbey, Dr.P.H.,, Alan J. Moskowitz, M.D.,, Marc Gillinov, M.D.,, Michael J. Mack, M.D.,, Pierre Voisine, M.D.,, Markus Krane, M.D.,, Babatunde Yerokun, M.D.,, Michael E. Bowdish, M.D.,, Lenard Conradi, M.D.,, Steven F. Bolling, M.D.,, Marissa A. Miller, D.V.M.,, Wendy C. Taddei-Peters, Ph.D.,, Neal O. Jeffries, Ph.D.,, Michael K. Parides, Ph.D.,, Richard Weisel, M.D.,, Mariell Jessup, M.D.,, Eric A. Rose, M.D.,, John C. Mullen, M.D.,, Samantha Raymond, M.P.H.,, Ellen G. Moquete, B.S.N.,, Karen O’Sullivan, M.P.H.,, Mary E. Marks, B.S.N.,, Alexander Iribarne, M.D.,, Friedhelm Beyersdorf, M.D.,, Michael A. Borger, M.D., Ph.D.,, Arnar Geirsson, M.D.,, Emilia Bagiella, Ph.D.,, Judy Hung, M.D.,, Annetine C. Gelijns, Ph.D.,, Patrick T. O’Gara, M.D.,, and Gorav Ailawadi, M.D.

Issue&Volume: 2021-11-13

Abstract:

Background

Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation.

Methods

We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death.

Results

Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P=0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60).

Conclusions

Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up.

DOI: 10.1056/NEJMoa2115961

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2115961

 

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home