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Comparison of Results of Tricuspid Valve Repair Versus Replacement for Severe Functional Tricuspid Regurgitation.

Title
Comparison of Results of Tricuspid Valve Repair Versus Replacement for Severe Functional Tricuspid Regurgitation.
Author
허란
Keywords
CONVENTIONAL TREATMENT; MITRAL REGURGITATION; EARLY SURGERY; ANNULOPLASTY; PREDICTORS; OUTCOMES; MANAGEMENT; DISEASE; MODELS
Issue Date
2017-05
Publisher
EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
Citation
AMERICAN JOURNAL OF CARDIOLOGY, v. 119, no. 6, page. 905-910
Abstract
The optimal decision regarding whether to repair or replace the tricuspid valve (TV) remains controversial in patients with very severe functional tricuspid regurgitation (TR). We sought to compare clinical outcomes of TV repair versus replacement for very severe TR associated with severe TV tethering. We included 96 consecutive patients (20 men, 58 11 years of age) who had both severe tethering of TV and very severe functional TR and consequently underwent TV surgery during left-sided valve surgery. TV repair was performed on 79 patients (repair group), whereas 17 patients underwent TV replacement (replacement group). The primary end point of the study was defined as the composite of operative mortality, cardiac death, repeat TV surgery, and hospitalization due to congestive heart failure during follow-up. The 2 groups had similar baseline clinical, echocardiographic, and operative characteristics, but operative mortality was significantly higher in the replacement group than in the repair group (p = 0.008). During a median follow-up of 87 months, 19 patients (24%) in the repair group and 8 (47%) in the replacement group attained the composite end point, and TV replacement was independently associated with end points in the Cox proportional hazards analysis after adjustment with propensity score (hazard ratio 4.033, 95% CI 1.470 to 11.071; p = 0.007). In conclusion, compared with TV repair, replacement was associated with higher operative mortality and worse long-term clinical outcomes in patients with very severe functional TR. Repair should be the preferred surgical option even for severe TR associated with more advanced tethering and right ventricular dilatation. (C) 2017 Elsevier Inc. All rights reserved.
URI
https://www.ajconline.org/article/S0002-9149(17)30068-1/fulltexthttps://repository.hanyang.ac.kr/handle/20.500.11754/114045
ISSN
0002-9149; 1879-1913
DOI
10.1016/j.amjcard.2016.11.071
Appears in Collections:
COLLEGE OF MEDICINE[S](의과대학) > MEDICINE(의학과) > Articles
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