三尖瓣位人工机械瓣与生物瓣置换的远期结果  

Long-term Outcomes of Mechanical Prosthetic versus Bioprosthetic Replacement in Tricuspid Position

作　　者：黄焕雷[1] 谢旭晶[2] 卢聪[1] 肖学钧[1] 吴若彬[1] 刘菁[1] 陈寄梅[1] 庄建[1] 

机构地区：[1]广东省心血管病研究所广东省医学科学院广东省人民医院心外科,广州510100 [2]中山大学附属第三医院心内科,广州510630

出　　处：《中国胸心血管外科临床杂志》2015年第5期418-422,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金："十二五"国家科技支撑计划项目(2011BAI11B22);广东省科技计划项目(2011B061300010);国家重点专科建设项目~~

摘　　要：目的比较采用人工机械瓣与人工生物瓣行三尖瓣置换术的远期疗效。方法回顾性分析2000年1月至2010年12月在广东省人民医院单纯或合并行三尖瓣置换术患者344例的临床资料,其中男117例、女227例,年龄8-74（42.0±13.3）岁。将患者分为两组：置换人工机械瓣为机械瓣组,168例（48.8%）,年龄（37.0±11.6）岁;置换人工生物瓣为生物瓣组,176例（51.2%）,年龄（46.0±13.4）岁。对出院患者采用门诊、电话、邮件等方法进行随访。结果随访时间2个月至12.6年,平均随访5.7年。生物瓣组患者149例生存出院,随访率96.6%（144/149）。30 d内死亡29例（16.5%）,30 d后死亡14例（7.9%）。生物瓣组发生退行性变18例,人工生物瓣感染性心内膜炎3例。机械瓣组患者152例生存出院,随访率93.4%（142/152）。30 d内死亡13例（7.7%）,30 d后死亡14例（8.3%）。三尖瓣机械瓣发生不同程度梗阻19例。未出现人工机械瓣感染性心内膜炎病例。生物瓣组和机械瓣组总死亡率（24.4%vs.16.1%,P=0.054）和再次手术率（4.2%vs.9.9%,P=0.051）差异无统计学意义。生物瓣组和机械瓣组的1年（78%vs.89%）、5年（74%vs.86%）、10年（66%vs.78%）生存率差异有统计学意义（P=0.003）,机械瓣组远期生存率高于生物瓣组。结论在三尖瓣置换术中选择机械瓣或生物瓣对总死亡率和再次手术率无显著影响。机械瓣组远期生存率高于生物瓣组,可能与两组患者年龄结构不同有关。在三尖瓣人工瓣膜感染性心内膜炎的发生率方面,生物瓣有高于机械瓣的趋势。Objective To compare the outcomes of mechanical prosthetic versus bioprosthetic replacement of tricuspid valve. Methods We retrospectively analyzed the clinical data of 344 patients underwent tricuspid valve replacement（TVR） in Guangdong General Hospital between January 2000 and December 2010. There were 227 female and 117 male patients with their age of 8-74（42.0±13.3） years. We allocated the patients into two groups： 168 patients（48.8%） at age of 37.0±11.6 years underwent mechanical tricuspid valve replacement（the MTVR group） and 176（51.2%） patients at age of 46.0±13.4 years underwent biological tricuspid valve replacement（the BTVR group）. Follow-up data were obtained via patients＇ visiting the outpatient clinic, telephone or mail contacts. Results The mean follow-up time was 5.7 years（ranged from 2 months to 12.6 years）. In the BTVR group, 149 patients survived to discharge from hospital, and 144 patients were followed-up successfully, giving a 96.6% follow-up rate. Early mortality（within 30 days post-operation） occurred in 29 patients（16.5%）, and 14 patients（7.9%） died after 30 days post-operation. Eighteen bioprosthetic valve degeneration was found during follow-up, and infective endocarditis in 3 patients. In the MTVR group, 152 patients survived to discharge from hospital, 142 patients（93.4%） were followed-up. Early mortality in 13 patients（7.7%）, and 14 patients（8.3%） died after 30 days post-operation. Nineteen patients suffered from mechanical prosthesis obstruction, no infective endocarditis patients was found in the MTVR group. There was no statistical difference between the BTVR group and the MTVR group in mortality rate（24.4% versus 16.1%, P=0.054） and in reoperation rate（4.2% versus 9.9%, P=0.051）, respectively.There were statistical differences in long-term survival rates between the BTVR group and the MTVR group with 1 year survival rate（78% vs. 89%）, 5 years survival rate（74% vs. 86%）, and 10 years survival rate（66% vers

关 键 词：三尖瓣置换术 人工机械瓣 人工生物瓣 

分 类 号：R654.2[医药卫生—外科学]