Prevalence and Outcomes of Isolated Tricuspid Valve Surgery Among Medicare Beneficiaries
Prevalence and Outcomes of Isolated Tricuspid Valve Surgery Among Medicare Beneficiaries
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DOI：
10.1016/j.amjcard.2018.09.016
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发表时间：
2019-01-01
影响因子：
2.8
通讯作者：
Yeh, Robert W.
中科院分区：
文献类型：
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作者：
Kundi, Harun;Popma, Jeffrey J.;Yeh, Robert W.
我们试图描述在美国接受孤立三尖瓣手术的临床结果并确定死亡率的预测因素。我们根据 2003 年 1 月至 2014 年 12 月期间医疗保险和医疗补助服务中心的医疗保险提供者分析和审查数据，确定了 5,164 名接受孤立三尖瓣手术的患者。主要结局是全因 1 年死亡率。采用向后消除法来确定 1 年死亡率的预测因素。 2,494 名 (48.3%) 患者进行了三尖瓣修复术，2,670 名 (51.7%) 患者进行了三尖瓣置换术。围手术期和 1 年死亡率分别为 9.9% 和 24.1%。 1 年死亡率的预测因素包括年龄 (p < 0.001)、慢性心力衰竭 (p = 0.001)、肝硬化 (p < 0.001)、类癌综合征 (p < 0.001)、慢性肾病 (p = 0.001)、继发性肺动脉高压 (p = 0.023)、心内膜炎 (p = 0.005)、褥疮 (p < 0.001）、营养不良（p < 0.001）、置换（p = 0.013）、急诊手术（p < 0.001）和术前休克（p < 0.001）。1 年死亡率的 C 统计值为 0.70（95% 置信区间，0.67 至 0.73）。 总之，很少进行孤立三尖瓣手术。在美国，与较高的 1 年死亡率相关，可以根据手术时是否存在多种合并症来识别患者。保留所有权利。
We sought to characterize the clinical outcomes and to identify predictors of mortality undergoing isolated tricuspid valve surgery in the United States. We identified 5,164 patients undergoing isolated tricuspid valve surgery from the Centers for Medicare and Medicaid Services Medicare Provider Analysis and Review data between January 2003 and December 2014. The primary outcome was all cause 1-year mortality. A backward elimination method was performed to identify predictors of 1-year mortality. Tricuspid valve repair was performed in 2,494 (48.3%) patients and tricuspid valve replacement was performed in 2,670 (51.7%) patients. Perioperative and 1-year mortality rates were 9.9% and 24.1%, respectively. Predictors of 1-year mortality were age (p < 0.001), chronic heart failure (p = 0.001, cirrhosis (p < 0.001), carcinoid syndrome (p < 0.001), chronic kidney disease (p = 0.001), secondary pulmonary hypertension (p = 0.023), endocarditis (p = 0.005), decubitus ulcer (p < 0.001), malnutrition (p < 0.001), replacement (p = 0.013), emergency procedure (p < 0.001), and preprocedural shock (p < 0.001). The C-statistic for 1-year mortality was 0.70 (95% confidence interval, 0.67 to 0.73). In conclusion, isolated tricuspid valve surgery is infrequently performed in the United States, and is associated with high 1-year mortality. Patients at higher risk for mortality can be identified based on the presence of a number of comorbidities at the time of surgery. (C) 2018 Elsevier Inc. All rights reserved.