摘要
目的总结改良三尖瓣环成形技术的近、中期疗效。方法2002年8月至2007年12月，连续158例左心系统瓣膜病变合并三尖瓣关闭不全患者行三尖瓣环成形手术治疗。158例患者中，男74例，女84例；年龄（47．3±12．0）岁。肺动脉收缩压（53．4±19．8）mmHg（1mmHg=0．133kPa）。三尖瓣轻度反流患者66例（41．8％），中度反流54例（34．2％），重度反流38例（24．0％）。术前轻度反流组三尖瓣瓣口直径（38．2±4．9）mm，中度反流组（47．0±11．6）mm，重度反流组（44．5±8．9）mm，P〈0．001。轻、中、重度反流组左心室射血分数分别为0．59±0．08、0．59±0．06、0．58±0．09，差异无统计学意义，P：0．73。三尖瓣成形手术适应证为中一大量三尖瓣反流或中度以上肺动脉高压病例（肺动脉收缩压〉40mmHg）。应用Cosgrove·Edwards成形环进行改良三尖瓣环成形术，在经典术式基础上尽可能采用小号三尖瓣成形环和隔瓣部分固定技术。通过多元回归和生存分析方法，评价近、中期疗效。结果术后少、中、大量反流组病例三尖瓣环缩小值分别为（12．4±5．6）mm、（20．8±11．5）mm、（18．6±8．3）mm，三尖瓣环少量反流组瓣口直径环缩幅度显著小于中、重度反流组（P〈0．001）。术后早期中量反流组1例患者死亡。术后157例患者获得中期随访，随访中位数为49．1个月。随访期间3例出现三尖瓣中、大量反流，其中，术前中度反流组1例，重度反流组2例，组间差异无统计学意义，P=0．06。中期随访中9例死亡，其中术前轻度反流组3例，中度反流组2例，重度反流组4例，组间差异无统计学意义，P=0．10。结论应用Cosgrove—Edwards成形环进行改良三尖瓣环成形术治疗左心系统瓣膜病变合并三尖瓣关闭不全中期效果良好。
Objective To improve short-and mid-term surgical outcomes ofter the tricuspid ring annuloplasty, and to provide theoretic basis for strategy making among patients with tricuspid regurgitation secondary to left-sided heart diseases. Methods Tricuspid regurgitation secondary to left-sided heart diseases （ including mitral valve diseases and aortic valve diseases） were treated by using tricuspid ring annuloplasty techniques. Patients＇age averaged （47.3 ± 12.0） years old, there were a total of 84 female patients（53.2% ）. The average systolic pulmonary pressure was （53.4 ± 19.8 ） mm Hg. From August 2002 to December 2007, a total of 158 consecutive patients underwent tricuspid ring annuloplasty in Fuwai Cardiovascular disease Hospital. Among this group of patients, there were 66 mild tricuspid regurgitation （41. 8 % ）, 54 moderate （34.2%）, and 38 severe tricuspid regurgitation（24.0% ）. The average age was （47.3 ~ 12.0） years old and female accounted for 53.2% of the whole cohort. The indications for the tricuspid ring annuloplasty included： moderate to severe tricuspid regurgitation or moderate to severe pulmonary hypertension （systolic pulmonary hypertension 〉 40 mm Hg）. In the current study, the ring an- nuloplasty techniques were modified in the following aspects ： selection of undersized ring and partial fixation of tricuspid septal segment. In all the patients, we chose Cosgrove-Edwards ring for tricuspid annuloplasty, The surgical outcomes were evaluated through multivariate regression and Cox analysis. Results Compared with moderate and severe tricuspid regurgitation groups,mild regurgitation group had the smallest ring diameter, mild group （ 38.2 -± 4.9 ） mm, moderate group （47.0 ± 11.6 ） ram, severe group （44.5 ±8.9 ） mm, P 〈 0.001. No significant differences were noted in terms of ejection fraction among three groups （0. 59 ± 0. 08, 0.59± 0.06 and 0.58 ± 0.09, P = 0.73 ）. Compared with mild and moderate tricuspid regurgitation groups, severe regurgitation group had the highest systolic pulmonary pressure. The diameter reduction was most significant in severe re- gurgitation group , diameter reduction in mild, moderate and severe regurgitation groups were （ 12.4± 5.6 ） mm, （20.8± 11.5） mm, （18.6 ±8.3） mm, respectively, P 〈 0. 001. An in-hospital death occurred in moderate regurgitation group. 157 patients discharged alive. The median follow-up time was 49.1 months. During follow up, three moderate to severe regurgita- tion occurred, among which one was in moderate regurgitation group, two in severe regurgitation group （ P = 0.06 ）. There were three deaths in mild regurgitation group, two in moderate regurgitation group, and four in severe regurgitation group. No significant differences were found in terms of mid-term mortality, P = 0.10. Conclusion For patients with tricuspid regurgitation secondary to left-sided heart diseases, the mid-term outcomes of modified Cosgrove-Edwards ring annuloplasty were satisfactory. The taking home messages include ： positive recommendation for patients with pulmonary hypertension to accept tricuspid annuloplasty, use of undersized ring, and partial fixation of septal segment.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2012年第5期285-288,共4页
Chinese Journal of Thoracic and Cardiovascular Surgery
关键词
三尖瓣闭锁不全
心脏瓣膜成形术
三尖瓣环
Tricuspid valve insufficienty Cardiac valve annuloplasty Tricuspid ring
