二尖瓣手术同期修复中度及以下三尖瓣关闭不全对三尖瓣及右心功能早中期预后的影响  

Concomitant repair of moderate or less tricuspid regurgitation during mitral valve surgery improves early and mid-term prognosis of tricuspid valve and right heart function

作　　者：赵若瑾 廉虹 王欣 ZHAO Ruojin;LIAN Hong;WANG Xin(Department of Cardiovascular Surgery,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing,100037,P.R.China;Animal Experimental Center,Fuwai Hospital,National Center for Cardiovascular Disease,Chinese Academy of Medical Sciences and Peking Union Medical College,State Key Laboratory of Cardiovascular Disease&Center for Cardiovascular Experimental Study and Evaluation,Beijing Key Laboratory of Pre-clinical Research and Evaluation for Cardiovascular Implant Materials,Beijing,100037,P.R.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、成人外科,北京100037 [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、心血管在体实验及评价中心、动物实验中心、心血管疾病国家重点实验室、心血管植入材料临床前研究评价北京市重点实验室,北京100037

出　　处：《中国胸心血管外科临床杂志》2023年第3期389-395,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：北京市科学技术委员会首都临床诊疗技术研究及转化应用项目(Z201100005520004)。

摘　　要：目的探讨二尖瓣手术同期修复中度及以下三尖瓣关闭不全对患者三尖瓣及右心功能早中期预后的影响。方法回顾性分析2011—2014年于阜外医院因二尖瓣疾病需要接受心脏外科手术合并中度及以下三尖瓣反流461例患者的临床资料,其中男309例、女152例,中位年龄53.00(44.00,60.00)岁。根据是否同期行三尖瓣手术修复(包括DeVega术和Kay’s术的缝线成形和成形环植入)分为单独二尖瓣手术组(nTAP组,289例)和同期三尖瓣手术组(TAP组,172例),记录两组患者手术前后左心室舒张末期内径、室间隔厚度、左心室后壁厚度、右心室内径的变化。同时对43例三尖瓣环直径<40 mm的TAP组患者术前、术后右心室内径变化进行亚组分析,探讨三尖瓣手术对改善患者右心功能的影响。结果中位随访时间为3.00(0.10~9.30)年。围术期无患者死亡。术后3个月,TAP组患者右心室前后径较nTAP组显著改善[右心室前后径变化分别为–1.00(–3.00,1.00)mm vs.0.00(–0.20,2.00)mm,P=0.048]。术后3年,TAP组右心室前后径的改善仍然较nTAP组患者显著[–1.00(–2.75,2.00)mm vs.2.00(–0.75,4.00)mm,P=0.014]。TAP组患者中度及以上三尖瓣反流发生率更低(3.64%vs.35.64%,P<0.001)。植入成形环与缝线成形相比防止反流进展的效果更好(P=0.044)。对于术前三尖瓣环直径<40 mm的患者三尖瓣手术仍对早期右心室前后径的改善有效(P=0.036)。结论二尖瓣手术同期对中度及以下三尖瓣反流患者进行三尖瓣修复能够有效改善患者术后早中期三尖瓣和右心功能,通过植入成形环修复三尖瓣能更好地阻止三尖瓣反流进展。术前瓣环直径<40 mm的患者同样能够从手术中获益。Objective To investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation.Methods A retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done.They were309 males and 152 females with a median age of 53.00(44.00,60.00)years.According to whether they received tricuspid valve repair(Kay’s annuloplasty,DeVega’s annuloplasty or annular ring implantation),the patients were divided into a mitral valve surgery only group(a nTAP group,n=289)and a concomitant tricuspid valve repair group(a TAP group,n=172).At the same time,43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups.Results The median follow-up duration was 3.00 years(range from 0.10 to9.30 years).There was no perioperative death.Three months after surgery,the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group[–1.00(–3.00,1.00)mm vs.0.00(–0.20,2.00)mm,P=0.048].Three years after surgery,the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group[–1.00(–2.75,2.00)mm vs.2.00(–0.75,4.00)mm,P=0.014],and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation(3.64%vs.35.64%,P<0.001).Annuloplasty ring implantation was more effective in preventing regurgitation progression(P=0.044).For patients with a tricuspid annulus diameter less than 40 mm,concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up(P=0.036).Conclusion Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral val

关 键 词：功能性三尖瓣反流 中度及以下三尖瓣反流 二尖瓣手术同期三尖瓣修复 右心功能 早中期预后 

分 类 号：R654.2[医药卫生—外科学]