608例三尖瓣置换术患者长期随访结果的倾向性评分匹配分析  

Long-term results of tricuspid valve replacement in 608 patients:A propensity score matching analysis

作　　者：杨亮 杨燕晨 颜倩 郑海云 周勘 刘菁[1] 黄焕雷[1] YANG Liang;YANG Yanchen;YAN Qian;ZHENG Haiyun;ZHOU Kan;LIU Jing;HUANG Huanlei(Department of Cardiovascular Surgery,Guangdong Provincial Cardiovascular Institute,Guangdong Provincial People’s Hospital,Guangdong Academy of Medical Sciences,Guangzhou,510080,P.R.China)

机构地区：[1]广东省人民医院,广东省医学科学院,广东省心血管病研究所心外科,广州510080

出　　处：《中国胸心血管外科临床杂志》2021年第7期777-787,共11页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省基础与应用基础基金(2019B1515120071);广东省自然科学基金(2016A030313799)。

摘　　要：目的探讨我院近20年三尖瓣置换(TVR)外科策略的转变、围术期及远期临床结果。方法回顾性分析1998~2018年在广东省人民医院心外科行TVR 608例患者的临床资料,其中男201例、女407例,中位年龄47.0(36.0,57.0)岁。根据植入人工瓣膜种类的不同,分为生物瓣(BTV,n=427)组和机械瓣(MTV,n=181)组。通过倾向性评分匹配,比较BTV组与MTV组围术期及远期临床结果。结果从2018年开始生物瓣的使用占比明显高于机械瓣。TVR术后住院死亡患者79例(13.0%)。倾向性评分匹配前,BTV组术后死亡率明显高于MTV组(15.2%vs.7.7%,P=0.012),匹配后两组死亡率差异无统计学意义(10.4%vs.7.2%,P=0.372)。倾向性评分匹配前BTV组术后呼吸机支持时间长于MTV组[22.0(15.0,37.0)h vs.19.0(11.0,27.0)h,P=0.003],术后透析、再次开胸止血发生率在BTV组比例更高(8.9%vs.2.8%,9.4%vs.6.6%)。匹配后两组死亡率差异无统计学意义,而MTV组术后肺部并发症比例更高(P=0.030)。出院患者中位随访时间为101.0(65.0,147.0)个月,时间范围为1~265个月,随访率为82.2%。随访期间共出现101例(19.1%)患者死亡,68例来自BTV组,33例来自MTV组。全部患者1年、5年、10年、15年以及20年的生存率分别为85.0%(95%CI 82.2~87.9)、78.9%(95%CI75.7~82.4)、71.1%(95%CI 67.3~75.3)、59.7%(95%CI 54.2~65.6)及51.7%(95%CI 43.3~60.7),匹配后两组患者远期生存情况差异无统计学意义(P=0.46)。三尖瓣生物瓣衰败中位时间为84.0(54.0,111.0)个月。结论TVR术后住院死亡率高,BTV组与MTV组早期死亡率与远期生存率差异无统计学意义,但再次手术率MTV组高于BTV组。在行TVR时,可根据患者的年龄、身体状态和医生的经验选择人工瓣膜的种类。Objective To explore the evolving strategies and compare perioperative and long-term outcomes of tricuspid valve replacement(TVR)in recent 20 years in our hospital.Methods Between 1998 and 2018,the clinical data of 608 patients who underwent TVR at the Department of Cardiac Surgery,Guangdong Provincial People’s Hospital were retrospectively analyzed.There were 201 males and 407 females,with a median age of 47.0(36.0,57.0)years.Patients were divided into a biological tricuspid valve(BTV,n=427)group and a mechanical tricuspid valve(MTV,n=181)group.Propensity score matching was used to balance the baseline difference.Surgical strategy evolving,postoperative and long-term outcomes were analyzed between the two groups.Results Since 2008,the usage ratio of biological valves was significantly higher than that of mechanical valves.Seventy-nine(13.0%)patients died in hospital after TVR.Before propensity score matching,the postoperative mortality of the BTV group was higher than that of the MTV group(15.2%vs.7.7%,P=0.012),and there was no statistical difference between the two groups after matching(10.4%vs.7.2%,P=0.372).The duration of postoperative ventilator support in the BTV group was longer than that in the MTV group[22.0(15.0,37.0)h vs.19.0(11.0,27.0)h,P=0.003],and the incidence of postoperative dialysis and rethoracotomy exploring for bleeding was higher in the BTV group(8.9%vs.2.8%,9.4%vs.6.6%,respectively).However,there was no statistical difference in mortality after matching.The median follow-up time of discharged patients was 101.0(65.0,147.0)months,ranged from 1 to 265 months,and the follow-up rate was 82.2%.During the follow-up period,there were 101 deaths(19.1%)of whom 68 were from the BTV group and 33 from the MTV group.The survival rates at 1 year,5 years,10 years,15 years and 20 years of all patients were 85.0%(95%CI 82.2-87.9),78.9%(95%CI 75.7-82.4),71.1%(95%CI67.3-75.3),59.7%(95%CI 54.2-65.6)and 51.7%(95%CI 43.3-60.7),and there was no statistical difference between the two groups after matching(P=0.46

关 键 词：三尖瓣置换 人工生物瓣 人工机械瓣 倾向性评分匹配分析 

分 类 号：R654.2[医药卫生—外科学]