JTCVS open最新文献_第4页

A less-invasive left atrial assist device concept for diastolic heart failure: First in vitro and in vivo assessment 治疗舒张性心力衰竭的微创左心房辅助装置概念：首次体外和体内评估

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.08.011

Chihiro Miyagi MD, PhD , Taiyo Kuroda MD , Barry D. Kuban BS , Shengquiang Gao PhD , Christine R. Flick BS, BME , Anthony R. Polakowski BS, MEng , Jamshid H. Karimov MD, PhD , Kiyotaka Fukamachi MD, PhD

Objective

A less-invasive left atrial assist device (LAADx) is a novel and implantable, extracardiac blood pump concept, intended for the treatment of diastolic heart failure, represented by heart failure with preserved ejection fraction.

Methods

A mixed-flow pump was used as the working LAADx model. Its performance was evaluated at 3 speeds, using an in vitro pulsatile mock circulatory loop, with a pneumatic pump that can simulate diastolic heart failure conditions by adjusting the diastolic drive pressure. The LAADx model was implanted in 4 healthy calves. The pump's inflow and outflow cannulas were inserted into the left atrium (LA) and left ventricle (LV), respectively, without cardiopulmonary bypass. The LAADx was operated at 3 speeds, and diastolic heart failure-like conditions were induced by inflating a balloon, inserted into the LV.

Results

With the in vitro study, diastolic heart failure-like conditions were successfully induced, exhibiting decreased cardiac output and aortic pressure as well as increased mean LA pressure both mitigated with the LAADx support. With regard to the in vivo study, simulated diastolic heart failure conditions showed a decrease in aortic pressure and an increase in LA pressure and LV end-diastolic pressure, which were again mitigated by the LAADx. Echocardiography showed good positioning of the outflow cannula and neither cardiac dysfunction nor mitral interference was observed.

Conclusions

Initial in vitro and in vivo results confirmed that the LAADx model, a device concept driven by creating an extracardiac route from the LA to LV, has the potential to mitigate high LA pressure and improve LV filling of heart failure with preserved ejection fraction pathology.

方法采用混流泵作为 LAADx 的工作模型。通过体外脉冲模拟循环回路，使用可通过调节舒张期驱动压力模拟舒张性心力衰竭情况的气动泵，在 3 种速度下对其性能进行了评估。LAADx 模型被植入 4 头健康小牛体内。泵的流入和流出插管分别插入左心房（LA）和左心室（LV），无需心肺旁路。结果在体外研究中，成功诱发了舒张性心力衰竭样病症，表现出心输出量和主动脉压降低，以及 LA 平均压升高，而 LAADx 的支持都缓解了这两种情况。在体内研究方面，模拟舒张性心力衰竭情况显示主动脉压力下降，LA 压力和左心室舒张末压力上升，LAADx 再次缓解了这些情况。结论初步的体外和体内研究结果证实，LAADx 模型是一种通过创建从 LA 到 LV 的心外路径来驱动的设备概念，它具有缓解 LA 压力过高和改善射血分数保留型心力衰竭 LV 充盈的潜力。

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引用次数: 0

Extended aortic coverage in thoracic aortic endovascular repair is not associated with spinal cord ischemia 胸主动脉血管内修复术中的主动脉扩大覆盖与脊髓缺血无关

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.08.010

George C. Chachati MD , Sarah Yousef MD , James A. Brown MD , Nishant Agrawal , Shwetabh Tarun , Kristian Punu , Derek Serna-Gallegos MD, FACS , Julie Phillippi PhD , Ibrahim Sultan MD

Objective

Spinal cord ischemia (SCI) after thoracic endovascular aortic repair (TEVAR) remains a debilitating complication, occurring in 10% of patients. Studies have shown that extended aortic coverage is a risk factor for SCI. This study evaluates whether extended aortic length coverage is a significant risk factor for SCI.

Methods

This study retrospectively reviewed 277 consecutive patients who underwent TEVAR successfully between 2006 and 2021 at a single institution. The patients were classified into 2 groups: ≥205 mm and <205 mm of thoracic aortic coverage. Analysis of variance was used to compare these variables and associated aortic coverage between the 2 groups. Univariable logistical regression was used to compare SCI and associated factors.

Results

Of the 269 patients who underwent successful TEVAR, 127 (47.2%) had ≥205 mm and 142 (52.8%) had <205 mm of aorta coverage. Patients with ≥205 mm of thoracic aorta coverage were more likely to be smokers (P < .01) and to have a history of previous stroke (P < .05). Patients with extended coverage were more likely to receive a preoperative lumbar drain (LD) (P < .01). Extended aortic coverage was not associated with a higher risk of SCI compared to standard aortic coverage (4.7% vs 4.2%; P = .84). Extended aortic coverage with or without a preoperative LD did not have an association with SCI (P = .91). Type II endoleaks were seen more in extended aortic coverage (P < .01).

Conclusions

Extended aortic coverage (compared with the standard approach) was not associated with a higher risk of SCI; however, this may have been mitigated by a higher prevalence of prophylactic lumbar drainage in this population.

目的胸腔内血管主动脉修复术（TEVAR）后脊髓缺血（SCI）仍是一种使人衰弱的并发症，10% 的患者会出现这种情况。研究表明，延长主动脉覆盖范围是导致 SCI 的一个风险因素。本研究评估了主动脉长度延长覆盖是否是 SCI 的重要风险因素。方法本研究回顾性分析了 2006 年至 2021 年期间在一家机构成功接受 TEVAR 的 277 例连续患者。患者被分为两组：胸主动脉覆盖范围≥205 mm和<205 mm。方差分析用于比较两组之间的这些变量和相关的主动脉覆盖情况。结果在成功接受 TEVAR 的 269 例患者中，127 例（47.2%）的主动脉覆盖范围≥205 mm，142 例（52.8%）的主动脉覆盖范围为 <205 mm。胸主动脉覆盖范围≥205 毫米的患者更有可能是吸烟者（P < .01）和既往有中风史者（P < .05）。覆盖范围扩大的患者更有可能在术前接受腰椎引流管（LD）治疗（P < .01）。与标准主动脉覆盖相比，扩大主动脉覆盖与较高的 SCI 风险无关（4.7% vs 4.2%; P = .84）。有无术前 LD 的主动脉扩大覆盖与 SCI 无关（P = .91）。结论扩大主动脉覆盖（与标准方法相比）与较高的 SCI 风险无关；但是，在该人群中，预防性腰椎引流的发生率较高，这可能会减轻 SCI 的风险。

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引用次数: 0

Using machine learning to predict neurologic injury in venovenous extracorporeal membrane oxygenation recipients: An ELSO Registry analysis 利用机器学习预测静脉体外膜氧合患者的神经损伤：ELSO 登记分析

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.06.013

Andrew Kalra BS , Preetham Bachina BS , Benjamin L. Shou BS , Jaeho Hwang MD , Meylakh Barshay BA , Shreyas Kulkarni BS , Isaac Sears BS , Carsten Eickhoff PhD , Christian A. Bermudez MD , Daniel Brodie MD , Corey E. Ventetuolo MD, MS , Glenn J.R. Whitman MD , Adeel Abbasi MD, ScM , Sung-Min Cho DO, MHS

Background

Venovenous extracorporeal membrane oxygenation (VV-ECMO) is associated with acute brain injury (ABI), including central nervous system (CNS) ischemia (defined as ischemic stroke or hypoxic-ischemic brain injury [HIBI]) and intracranial hemorrhage (ICH). Data on prediction models for neurologic outcomes in VV-ECMO are limited.

Methods

We analyzed adult (age ≥18 years) VV-ECMO patients in the Extracorporeal Life Support Organization (ELSO) Registry (2009-2021) from 676 centers. ABI was defined as CNS ischemia, ICH, brain death, and seizures. Data on 67 variables were extracted, including clinical characteristics and pre-ECMO/on-ECMO variables. Random forest, CatBoost, LightGBM, and XGBoost machine learning (ML) algorithms (10-fold leave-one-out cross-validation) were used to predict ABI. Feature importance scores were used to pinpoint the most important variables for predicting ABI.

Results

Of 37,473 VV-ECMO patients (median age, 48.1 years; 63% male), 2644 (7.1%) experienced ABI, including 610 (2%) with CNS ischemia and 1591 (4%) with ICH. The areas under the receiver operating characteristic curve for predicting ABI, CNS ischemia, and ICH were 0.70, 0.68, and 0.70, respectively. The accuracy, positive predictive value, and negative predictive value for ABI were 85%, 19%, and 95%, respectively. ML identified higher center volume, pre-ECMO cardiac arrest, higher ECMO pump flow, and elevated on-ECMO serum lactate level as the most important risk factors for ABI and its subtypes.

Conclusions

This is the largest study of VV-ECMO patients to use ML to predict ABI reported to date. Performance was suboptimal, likely due to lack of standardization of neuromonitoring/imaging protocols and data granularity in the ELSO Registry. Standardized neurologic monitoring and imaging are needed across ELSO centers to detect the true prevalence of ABI.

背景静脉体外膜氧合（VV-ECMO）与急性脑损伤（ABI）有关，包括中枢神经系统（CNS）缺血（定义为缺血性卒中或缺氧缺血性脑损伤[HIBI]）和颅内出血（ICH）。我们分析了体外生命支持组织（ELSO）登记处（2009-2021 年）中来自 676 个中心的成人（年龄≥18 岁）VV-ECMO 患者。ABI定义为中枢神经系统缺血、ICH、脑死亡和癫痫发作。提取了67个变量的数据，包括临床特征和ECMO前/ECMO上变量。采用随机森林、CatBoost、LightGBM 和 XGBoost 机器学习（ML）算法（10 倍留一交叉验证）预测 ABI。结果在 37,473 例 VV-ECMO 患者（中位年龄 48.1 岁；63% 为男性）中，2644 例（7.1%）出现 ABI，其中 610 例（2%）伴有中枢神经系统缺血，1591 例（4%）伴有 ICH。预测 ABI、中枢神经系统缺血和 ICH 的接收器操作特征曲线下面积分别为 0.70、0.68 和 0.70。ABI 的准确率、阳性预测值和阴性预测值分别为 85%、19% 和 95%。ML将较高的中心容量、ECMO前心脏骤停、较高的ECMO泵流量和ECMO时血清乳酸水平升高确定为ABI及其亚型的最重要风险因素。可能是由于 ELSO 登记处的神经监测/成像方案和数据粒度缺乏标准化，该研究的效果并不理想。各 ELSO 中心需要进行标准化的神经监测和成像，以检测 ABI 的真实发生率。

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引用次数: 0

Regional variation in donation after circulatory death heart allograft utilization 循环死亡后捐献心脏异体移植利用率的地区差异

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.004

Oliver K. Jawitz MD, MHS , Adam D. Devore MD , Chetan B. Patel MD , Jeffrey E. Keenan MD , Carmelo A. Milano MD , Jacob N. Schroder MD

Objective

Randomized data support transplantation of hearts from donors after circulatory death. This may lead to a sizeable increase in the donor pool. Regional variations in donors after circulatory death heart use were examined to help elucidate barriers to donor pool expansion.

Methods

The United Network for Organ Sharing deceased donor dataset was queried for adult (age ≥ 18 years) donors after circulatory death donors of at least 1 organ between January 2020 and December 2023. Donors were stratified by the extent their respective cardiac allografts progressed through the donation process. United Network for Organ Sharing region-level use rates and annual trends were assessed.

Results

Of 17,239 adult donors after circulatory death donors who donated at least 1 organ for transplant during the study period, 1196 (9.4%) were heart donors. Regional donors after circulatory death heart donor pursuit rates ranged from 97% to 100%, consent attainment rates from 94% to 99%, and heart recovery rates from 5% to 10%. The transplantation rate of recovered organs ranged from 90% to 97%. Multivariable logistic regression demonstrated United Network for Organ Sharing region to be independently associated with donors after circulatory death heart use after controlling for baseline differences in donor risk.

Conclusions

Transplantation of donors after circulatory death heart allografts has increased in the United States since 2020, but the overall number of hearts procured and transplanted from donors after circulatory death donors remains low. The operational barriers to transplantation of donors after circulatory death hearts require further investigation. Further, significant regional variation exists regarding rates of progression of donors after circulatory death hearts through the donation process. Sharing of successful practices among Organ Procurement Organizations and transplant centers will facilitate maximal use of this new donor pool.

目标随机数据支持对循环死亡后的供体进行心脏移植。这可能会导致供体库的大量增加。方法查询了器官共享联合网络（United Network for Organ Sharing）的已故捐献者数据集，以了解 2020 年 1 月至 2023 年 12 月期间至少捐献过 1 个器官的成人（年龄≥18 岁）循环死亡后捐献者的情况。根据捐献者各自的心脏同种异体器官在捐献过程中的进展程度对捐献者进行了分层。结果在研究期间，17239 名成人循环死亡后捐献者捐献了至少 1 个器官用于移植，其中 1196 人（9.4%）是心脏捐献者。循环死亡后心脏捐献者的区域追寻率从 97% 到 100% 不等，同意率从 94% 到 99%，心脏回收率从 5% 到 10% 不等。回收器官的移植率为 90% 至 97%。多变量逻辑回归表明，在控制了捐献者风险的基线差异后，器官共享联合网络地区与循环死亡后捐献者心脏使用情况独立相关。循环死亡后供体心脏移植的操作障碍需要进一步调查。此外，在循环死亡后捐献者心脏的捐献过程中，各地区的进展率存在很大差异。器官获取组织和移植中心之间分享成功经验将有助于最大限度地利用这一新的供体库。

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引用次数: 0

Commentator Discussion: Are there etiology specific risk factors for adverse outcomes in patients with surgically implanted 5.5 liter temporary microaxial transvalvular left ventricular assist devices? 评论员讨论：Impella 5.5 支持患者的不良预后是否存在特定病因的风险因素？

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.006

引用次数: 0

Discussion to: Outcomes of pediatric heart transplantation in children with selected genetic syndromes 讨论到：特定遗传综合征患儿的小儿心脏移植结果

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.06.014

引用次数: 0

Lung cancer screening among minority groups: Identifying gaps in screening and opportunities for intervention 少数群体中的肺癌筛查：确定筛查差距和干预机会

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.001

Fatima G. Wilder MD, MSc, MPH , Busra Cangut MD, MS , Rajika Jindani MD, MPH, MS , Oyepeju Abioye MD, MSc , Narjust Florez MD

引用次数: 0

Replacing post–chest tube removal chest radiographs with clinical assessment in adult thoracic surgery patients: A single-center prospective study 用临床评估取代成人胸腔手术患者胸管拔除后胸部 X 光检查；一项单中心前瞻性研究

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.07.015

Andreea C. Matei MD, MSc , Awrad Nasralla MD , Najib Safieddine MD, FRCSC , Sayf Gazala MD, FRCSC , Carmine Simone MD, FRCSC , Negar Ahmadi MD, MSc, MPH, FRCSC

Objective

The necessity and utility of chest radiographs in the absence of clinical symptoms have been questioned after chest tube removal. This study aimed to evaluate the impact of replacing routine chest radiographs after chest tube removal with clinical observation on outcomes in patients undergoing elective thoracic surgery.

Methods

This was a single-center prospective study of adult patients undergoing elective lung resection. Standard chest radiographs after chest tube removal were replaced with a clinical observation protocol for 2 hours after removal. Chest radiographs after chest tube removal were meant to be obtained only for symptomatic patients. The primary outcome was the incidence of adverse events related to this change. Secondary outcomes included changes in clinical management, length of stay, and postoperative complications.

Results

A total of 248 patients were included in the study period, and the majority (n = 185, 75%) did not have chest radiographs after chest tube removal. There was no significant difference in the incidence of adverse events or postoperative complications between patients who received chest radiographs and those who did not. Additionally, length of stay was significantly shorter in patients who did not receive chest radiographs (median 2.3 vs 3 days; P < .05).

Conclusions

Clinical observation can safely replace routine chest radiographs after chest tube removal in asymptomatic patients undergoing elective thoracic surgery. This approach may lead to shorter hospital stays and reduced healthcare costs without compromising patient safety. The findings support a clinically driven use of postoperative imaging in this patient population, highlighting the importance of individualized patient care.

摘除胸管后，在无临床症状的情况下进行胸片检查的必要性和实用性受到质疑。本研究旨在评估在拔除胸管后用临床观察取代常规胸片对接受择期胸外科手术的患者预后的影响。方法这是一项针对接受择期肺切除术的成年患者的单中心前瞻性研究。拔除胸管后的标准胸片检查被拔管后 2 小时的临床观察方案所取代。胸管拔除后的胸片检查仅针对有症状的患者。主要结果是与这一改变相关的不良事件发生率。次要结果包括临床管理、住院时间和术后并发症的变化。结果研究期间共纳入了 248 名患者，其中大部分（185 人，75%）在拔除胸管后没有进行胸部 X 光检查。接受胸片检查的患者与未接受胸片检查的患者在不良事件或术后并发症的发生率上没有明显差异。结论对于接受择期胸外科手术的无症状患者，临床观察可以安全地取代胸管拔除后的常规胸片检查。这种方法可缩短住院时间，降低医疗成本，同时不影响患者安全。研究结果支持在这一患者群体中使用临床驱动的术后成像，强调了对患者进行个体化护理的重要性。

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引用次数: 0

Reoperation after aortic root replacement and its impact on long-term survival 主动脉根置换术后再手术及其对长期生存的影响

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.05.003

Objective

Reoperation after aortic root replacement (ARR) is associated with increased operative risk and complexity. This study evaluated clinical outcomes and reoperation rates in patients undergoing ARR.

Methods

From 2004 to 2021, 2700 adult patients underwent an ARR in a 2-institution database. Among 2542 surviving patients, 705 patients who had a history of previous cardiac surgery as well as 11 patients who underwent transcatheter aortic valve replacement after index ARR were excluded. Among the finalized cohort of 1826 patients, 88 (4.8%) underwent a reoperation (REDO) on the aortic valve or proximal aorta (root/ascending) a mean of 3.1 years after index ARR whereas 1738 (95%) did not undergo reoperation (no-REDO). A subgroup analysis was performed among those undergoing reoperation by indication including valve dysfunction (48%), endocarditis/graft infection (33%), and aortic aneurysm/dissection/rupture (12%). Reoperative indication was unknown in 6 patients (7%).

Results

The REDO group was younger at time of index ARR (52 vs 58 years, P < .0001) and had more bicuspid aortic valves (56% vs 37%, P = .0003). Most patients underwent modified Bentall ARR (61%), whereas 38% underwent a valve-sparing root replacement. Index root operations were similar between groups. At time of reoperation, 53% underwent aortic valve replacement and 35% underwent redo root replacement. Long-term survival was similar between REDO and no-REDO groups (80% vs 85%, P = .26) and reoperation was not a risk factor for late mortality (hazard ratio, 1.31; P = .26); however, REDO ARR was a risk factor for late mortality (hazard ratio, 2.41; P = .02).

Conclusions

The incidence of aortic valve and/or proximal aorta reoperation after index ARR is relatively low at 4.8%; however, root reoperation is a risk factor for late mortality.

目的主动脉根部置换术（ARR）后再次手术与手术风险和复杂性增加有关。本研究评估了主动脉根部置换术患者的临床预后和再次手术率。方法从 2004 年到 2021 年，两家机构的数据库中共有 2700 名成年患者接受了主动脉根部置换术。在 2542 名存活患者中，排除了 705 名既往有心脏手术史的患者，以及 11 名在指数 ARR 后接受经导管主动脉瓣置换术的患者。在最终确定的 1826 例患者中，88 例（4.8%）在指数 ARR 后平均 3.1 年接受了主动脉瓣或主动脉近端（根部/升支）的再次手术（REDO），而 1738 例（95%）没有接受再次手术（无 REDO）。根据瓣膜功能障碍（48%）、心内膜炎/移植物感染（33%）和主动脉瘤/夹层/破裂（12%）等适应症对接受再次手术的患者进行了亚组分析。6名患者（7%）的再手术指征不明。结果REDO组患者在进行指数ARR时年龄较小（52岁 vs 58岁，P < .0001），双尖主动脉瓣较多（56% vs 37%，P = .0003）。大多数患者接受了改良 Bentall ARR（61%），而 38% 的患者接受了保留瓣膜的根部置换术。两组患者的根部指数手术相似。再次手术时，53%的患者接受了主动脉瓣置换术，35%的患者接受了重做根部置换术。REDO 组和非 REDO 组的长期生存率相似（80% vs 85%，P = .26），重新手术不是晚期死亡的风险因素（危险比 1.31；P = .26）；但是，REDO ARR 是晚期死亡的风险因素（危险比 2.41；P = .02）。

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引用次数: 0

Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality 三尖瓣手术治疗急性感染性心内膜炎的手术死亡率非常低

JTCVS open

Pub Date : 2024-10-01 DOI: 10.1016/j.xjon.2024.06.012

Ali Darehzereshki MD, J. Hunter Mehaffey MD, MSc, J.W. Awori Hayanga MD, MPH, Lawrence Wei MD, Taylor D'etcheverry PA-C, Luigi F. Lagazzi MD, Vinay Badhwar MD

Objective

Tricuspid valve surgery historically has been perceived as having elevated operative risk, prompting the recent development of transcatheter therapies including aspiration vegetectomy for endocarditis. The opioid epidemic has exacerbated tricuspid valve endocarditis, particularly in people who inject drugs. We sought to evaluate contemporary outcomes of tricuspid valve surgery in real-world practice.

Methods

An institutional multidisciplinary endocarditis database inclusive of clinical, microbiologic, and echocardiographic data was analyzed for those undergoing isolated or concomitant tricuspid valve surgery for acute active endocarditis. Consecutive patients between 2016 and 2021 were followed for longitudinal outcomes.

Results

A total of 283 patients with tricuspid valve endocarditis underwent tricuspid valve repair (n = 137, 48.4%) or replacement (n = 146, 51.6%). Median age was 31 (27-37) years, 63.1% were female, and 257 (90.8%) were active people who inject drugs. The leading indications for surgery were severe valvular insufficiency (71.2%), vegetation size greater than 2 cm (51.3%), or septic shock (23.3%). Concomitant procedures were performed in 44 patients (15.5%). In patients who underwent isolated tricuspid valve surgery (n = 239), no patient required permanent pacemaker after tricuspid valve repair, whereas 13.3% required permanent pacemaker after tricuspid valve replacement. Overall and isolated tricuspid valve surgery operative mortality were 1.8% and 1.3%, respectively. Overall and isolated tricuspid valve surgery 1-year survivals were 89.3% and 89.7%, respectively.

Conclusions

Tricuspid valve surgery for endocarditis has low operative mortality. When feasible, repair is preferred over replacement. In an era of promulgation of investigational therapies, heart teams should note that tricuspid valve surgery is low risk and remains the first-line beyond antibiotics.

摘要：三尖瓣手术历来被认为具有较高的手术风险，这促使近来经导管疗法的发展，包括针对心内膜炎的抽吸植物瓣切除术。阿片类药物的流行加剧了三尖瓣心内膜炎，尤其是注射毒品者。我们试图评估现实世界中三尖瓣手术的当代疗效。方法分析了因急性活动性心内膜炎而接受孤立或同时接受三尖瓣手术的患者的临床、微生物学和超声心动图数据，并建立了一个包含临床、微生物学和超声心动图数据的机构多学科心内膜炎数据库。结果共有283名三尖瓣心内膜炎患者接受了三尖瓣修复术（137人，48.4%）或置换术（146人，51.6%）。中位年龄为 31（27-37）岁，63.1% 为女性，257（90.8%）人为注射毒品的活跃人群。手术的主要适应症是严重瓣膜功能不全（71.2%）、植被大小超过 2 厘米（51.3%）或脓毒性休克（23.3%）。44名患者（15.5%）同时接受了手术。在接受孤立三尖瓣手术的患者中（n = 239），没有患者在三尖瓣修复术后需要永久性起搏器，而有 13.3% 的患者在三尖瓣置换术后需要永久性起搏器。三尖瓣手术整体死亡率为1.8%，单独手术死亡率为1.3%。结论三尖瓣手术治疗心内膜炎的手术死亡率较低。结论三尖瓣手术治疗心内膜炎的手术死亡率较低，在可行的情况下，修复手术优于置换手术。在研究疗法不断涌现的时代，心脏团队应注意三尖瓣手术风险低，仍是抗生素之外的一线治疗方案。

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引用次数: 0