TY - JOUR
T1 - Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation
AU - Chen, Shao Wei
AU - Tsai, Feng Chun
AU - Tsai, Feng Chang
AU - Chao, Yin Kai
AU - Huang, Yao Kuang
AU - Chu, Jaw Ji
AU - Lin, Pyng Jing
PY - 2012/3
Y1 - 2012/3
N2 - Background: Late tricuspid regurgitation after previous cardiac operation remains controversial in terms of when to repair and who will benefit. We reviewed our surgical experiences and stratified the risk factors for death and morbidity. Methods: From September 2005 to September 2010, 77 consecutive patients (36 men [47%]) underwent redo open heart operations with the tricuspid valve (TV) procedure. Their mean age was 56 ± 13 years (range, 27 to 83 years). TV repair was performed in 44 (57%) and TV replacement in 33 (43%): 23 received bioprostheses; 10 received mechanical prostheses. Results: Fourteen (18%) patients died after the operation. Risk factors of hospital death by multivariate analysis were age (>65 years), preoperative renal insufficiency (creatinine >2 mg/dL), and preoperative severe liver cirrhosis (Child classification C). Compared with the group that underwent TV repair, those who underwent TV replacement tended to have had previous TV operations (46% vs 9%; p < 0.001) and preoperative Child class C liver cirrhosis (21% vs 2%; p = 0.018). Although in-hospital mortality was insignificant (24% vs 14%; p = 0.232), postoperative morbidities of tracheotomy, gastrointestinal bleeding, and late death were higher in the replacement group. Conclusions: Patients who had previous TV operations and preoperative severe liver cirrhosis were more likely to undergo TV replacement in tricuspid reoperations. Compared with patients in the repair group, patients in the replacement group had higher morbidities and low late survival. Earlier intervention, before decompensated heart failure occurs, is warranted to improve the outcome.
AB - Background: Late tricuspid regurgitation after previous cardiac operation remains controversial in terms of when to repair and who will benefit. We reviewed our surgical experiences and stratified the risk factors for death and morbidity. Methods: From September 2005 to September 2010, 77 consecutive patients (36 men [47%]) underwent redo open heart operations with the tricuspid valve (TV) procedure. Their mean age was 56 ± 13 years (range, 27 to 83 years). TV repair was performed in 44 (57%) and TV replacement in 33 (43%): 23 received bioprostheses; 10 received mechanical prostheses. Results: Fourteen (18%) patients died after the operation. Risk factors of hospital death by multivariate analysis were age (>65 years), preoperative renal insufficiency (creatinine >2 mg/dL), and preoperative severe liver cirrhosis (Child classification C). Compared with the group that underwent TV repair, those who underwent TV replacement tended to have had previous TV operations (46% vs 9%; p < 0.001) and preoperative Child class C liver cirrhosis (21% vs 2%; p = 0.018). Although in-hospital mortality was insignificant (24% vs 14%; p = 0.232), postoperative morbidities of tracheotomy, gastrointestinal bleeding, and late death were higher in the replacement group. Conclusions: Patients who had previous TV operations and preoperative severe liver cirrhosis were more likely to undergo TV replacement in tricuspid reoperations. Compared with patients in the repair group, patients in the replacement group had higher morbidities and low late survival. Earlier intervention, before decompensated heart failure occurs, is warranted to improve the outcome.
UR - http://www.scopus.com/inward/record.url?scp=84863233128&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2011.11.057
DO - 10.1016/j.athoracsur.2011.11.057
M3 - 文章
C2 - 22364972
AN - SCOPUS:84863233128
SN - 0003-4975
VL - 93
SP - 770
EP - 775
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -