三尖瓣置换术治疗成人先天性矫正性大动脉转位的远期临床结果及其危险因素分析  

Long-term outcome and risk factor analysis of tricuspid valve replacement for adult patients with congenitally corrected transposition of great arteries

作　　者：李琦 邓隆 许建屏 孙寒松 刘盛 宋云虎 LI Qi;DENG Long;XU Jianping;SUN Hansong;LIU Sheng;SONG Yunhu(Department of Adult Cardiac Surgery, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China)

机构地区：[1]中国医学科学院阜外医院成人心脏外科

出　　处：《中国胸心血管外科临床杂志》2019年第9期884-888,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的评价三尖瓣置换术(tricuspid valve replacement,TVR)作为一种缓解症状的手术方式,治疗先天性矫正性大动脉转位(congenitally corrected transposition of the great artery,CCTGA)成年患者的远期临床效果及其危险因素。方法回顾性分析阜外医院 2000~2017 年年龄>14 岁的 CCTGA 行三尖瓣置换术 47 例患者的临床资料。其中男 27 例、女 20 例,手术年龄 14~62(38.8±13.5)岁。术前所有患者超声均提示三尖瓣中量或以上反流。结果平均随访时间(6.5±3.7)年,患者 1 年、5 年、10 年生存率或免于心脏移植发生率分别为 94.6%、90.5%、61.7%。随访期间,大多数患者(>90%)远期右心室射血分数仍≥40%。术前右心室舒张期末直径(right ventricular end diastolic diameter,RVEDD)增大是术后患者死亡或心脏移植的危险因素(风险比 1∶11,P=0.04)。术前 RVEDD≥60 mm 的患者生存率显著降低(P=0.032)。结论 TVR 对于 CCTGA 是一种可行的治疗方式。术前 RVEDD 增大是术后远期死亡的危险因素。Objective To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrected transposition of the great artery (CCTGA). Method We retrospectively analyzed the clinical data of 47 adult patients with CCTGA who underwent tricuspid valve replacement in Fuwai Hospital between 2000 and 2017 year. There were 27 males and 20 females with operation age of 14-62 (38.8±13.5) years. Preoperative echocardiography showed moderate or more tricuspid regurgNation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results The average follow-up time was 6.5±3.7 years. The 1-year, 5-year and 10-year survival rate or the incidence of heart transplant-free was 94.6%, 90.5% and 61.7%, respectively. During the follow-up period, the longterm right ventricular ejection fraction of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1 I 11, P=0.04). The survival rate of patients with RVEDD (>60 mm) before operation was significantly reduced (P=0.032). Conclusion TVP is a feasible treatment for adult patients with CCTGA. The increase of preoperative RVEDD is a risk factor for long-term mortality.

关 键 词：三尖瓣置换术 先天性心脏病 矫正性大动脉转位 

分 类 号：R654.2[医药卫生—外科学]