PDF(Pubmed)
Abstract：
OBJECTIVE: To describe evolving demographic trends and early outcomes in patients undergoing triple-valve surgery in the UK between 2000 and 2019.
METHODS: We planned a retrospective analysis of national registry data including patients undergoing triple-valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort.
RESULTS: We identified 1750 patients undergoing triple-valve surgery in the UK between 2000 and 2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 ± 12 years, having increased from 63 ±12 years in group A to 69 ± 12 years in group E (P < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (P < 0.001). Overall rates of re-exploration for bleeding (11%, P = 0.308) and postoperative dialysis (11%, P = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality.
CONCLUSIONS: Triple-valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.
METHODS: We planned a retrospective analysis of national registry data including patients undergoing triple-valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort.
RESULTS: We identified 1750 patients undergoing triple-valve surgery in the UK between 2000 and 2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 ± 12 years, having increased from 63 ±12 years in group A to 69 ± 12 years in group E (P < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (P < 0.001). Overall rates of re-exploration for bleeding (11%, P = 0.308) and postoperative dialysis (11%, P = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality.
CONCLUSIONS: Triple-valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.
摘要：
目的：描述在英国接受三瓣膜手术的患者不断变化的人口趋势和早期结果，2000-2019年之间。
方法：我们计划对国家注册数据进行回顾性分析，包括接受三瓣手术的患者的所有病因。我们排除了处于严重术前状态的患者和那些错过入院日期的患者。研究队列分为5个连续的4年队列(A组，B,C,D和E）。主要结果是住院死亡率，次要结果包括延长入院时间，重新探查出血,术后中风和术后透析。二元logistic回归模型用于建立死亡率的独立预测因子。中风,在这一高风险队列中进行术后透析和再出血探查。
结果：我们确定了2000年至2019年间在英国接受三瓣膜手术的1,750名患者。三瓣膜手术占数据集中所有患者的3.1%。患者的总体平均年龄为68.5岁±12，从A组的63岁±12增加到E组的69岁±12（p<0.001）。总体住院死亡率为9%，从A组的21%下降到E组的7%(p<0.001)。出血的总再探查率（11%，p=0.308）和术后透析（11%，p=0.066)在整个观察到的时间段内保持较高。三瓣膜置换，再次胸骨切开术和术前左心室射血分数差是死亡率的独立预测因子.
结论：三瓣膜手术在英国仍然很少见。随着时间的推移，三瓣膜手术的术后早期结果有所改善。重做胸骨切开术是死亡率的重要预测指标。在技术上可能的情况下，应尝试修复二尖瓣和/或三尖瓣。
方法：我们计划对国家注册数据进行回顾性分析，包括接受三瓣手术的患者的所有病因。我们排除了处于严重术前状态的患者和那些错过入院日期的患者。研究队列分为5个连续的4年队列(A组，B,C,D和E）。主要结果是住院死亡率，次要结果包括延长入院时间，重新探查出血,术后中风和术后透析。二元logistic回归模型用于建立死亡率的独立预测因子。中风,在这一高风险队列中进行术后透析和再出血探查。
结果：我们确定了2000年至2019年间在英国接受三瓣膜手术的1,750名患者。三瓣膜手术占数据集中所有患者的3.1%。患者的总体平均年龄为68.5岁±12，从A组的63岁±12增加到E组的69岁±12（p<0.001）。总体住院死亡率为9%，从A组的21%下降到E组的7%(p<0.001)。出血的总再探查率（11%，p=0.308）和术后透析（11%，p=0.066)在整个观察到的时间段内保持较高。三瓣膜置换，再次胸骨切开术和术前左心室射血分数差是死亡率的独立预测因子.
结论：三瓣膜手术在英国仍然很少见。随着时间的推移，三瓣膜手术的术后早期结果有所改善。重做胸骨切开术是死亡率的重要预测指标。在技术上可能的情况下，应尝试修复二尖瓣和/或三尖瓣。
