与经导管三尖瓣置换手术近期结果相关的术前超声心动图特征  

Factors Influencing the Short and Mid-Term Results of Transcatheter Tricuspid Valve Replacement

作　　者：赵星 孟红 王建德 刘倩倩 田月 高一鸣 段福建 施浩 潘湘斌 王浩[1] ZHAO Xing;MENG Hong;WANG Jiande;LIU Qianqian;TIAN Yue;GAO Yiming;DUAN Fujian;SHI Hao;PAN Xiangbin;WANG Hao(Department of Echocardiography,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China;Department of Structural Heart Disease,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院超声影像中心 [2]中国医学科学院、北京协和医学院、国家心血管病中心、阜外医院结构性心脏病中心

出　　处：《中国分子心脏病学杂志》2022年第5期4931-4938,共8页Molecular Cardiology of China

摘　　要：目的探讨与经导管三尖瓣置换手术后不良事件相关的重要术前超声心动图特征。方法连续纳入2020年6月至2021年8月阜外医院收治的药物治疗无效的症状性重度三尖瓣反流拟接受经导管三尖瓣置换术的患者。所有入组患者采集术前、出院前及随访期临床和超声心动图资料。结果共入选36例重度三尖瓣反流患者,男5例,女31例,年龄(65.4±7.8)岁。所有患者均具有右心衰竭的临床表现,纽约心脏学会心功能分级:Ⅲ级23例,Ⅳ级13例。术前超声心动图显示,三尖瓣重度反流,右心房、室扩大,三尖瓣环收缩期位移、右室面积变化分数及射血分数正常,肺动脉收缩压(36.7±10.6)mmHg。经导管三尖瓣置换术后,中位随访时间为11.7个月(0.3~19.9个月)。随访期间共3例(8.3%)患者死亡。术后3例患者早期出现心功能及肝肾功能不全,2例使用体外膜肺氧合(ECMO)辅助,4例因心力衰竭再次住院,免于心力衰竭等不良事件生存的患者共27例(75%)。在调整了年龄、性别、身高、体重等混杂因素后,术前反映右心房、室大小的超声指标、二尖瓣平均跨瓣压差、估测的肺动脉收缩压为手术结局的独立影响因素。结论接受经导管三尖瓣手术的重度三尖瓣反流患者,右心腔大小、二尖瓣跨瓣压差、肺动脉收缩压是与不良事件相关的重要术前超声指标。Objective To explore the preoperative echocardiographic features associated with adverse events after transcatheter tricuspid valve replacement.Methods From June 2020 to August 2021,patients with medically refractory symptomatic severe tricuspid regurgitation undergoing transcatheter tricuspid valve replacement in Fuwai Hospital were consecutively enrolled.All enrolled patients’clinical and echocardiographic data were collected preoperative,before discharge,and during followup.Results From June 2020 to August 2021,thirty-six patients[5 males and 31 females,mean age(65.4±7.8)years]with severe tricuspid regurgitation were enrolled.All patients had clinical manifestations of right heart failure.According to New York Heart Association(NYHA)classification,23 patients were in class Ⅲ and 13 in class Ⅳ.Preoperative echocardiography showed severe tricuspid regurgitation,enlarged right atrium and ventricle,normal tricuspid annular plane systolic excursion,right ventricular fractional area change and ejection fraction,and pulmonary artery systolic pressure of(36.7±10.6)mmHg.The median follow-up time after transcatheter tricuspid valve replacement was 11.7 months(range 0.3-19.9 months).Three patients(8.3%)died during the follow-up period.Two patients received extracorporeal membrane oxygenation(ECMO)support,and four were re-hospitalized due to heart failure.Twenty-seven patients(75%)survived without heart failure and other adverse events.After adjusting for confounding factors such as age,gender,height,and weight,preoperative echocardiographic parameters reflecting the size of the right atrium and ventricle,mean mitral valve gradient,and estimated pulmonary artery systolic pressure were independent influencing factors of surgical outcome.Conclusion In patients with severe tricuspid regurgitation undergoing transcatheter tricuspid valve surgery,right chamber size,mitral valve transvalvular pressure difference,and pulmonary systolic blood pressure are important preoperative echocardiographic indicators related to adve

关 键 词：三尖瓣反流 三尖瓣置换术 经导管治疗 

分 类 号：R654.2[医药卫生—外科学]