重度三尖瓣反流患者行经导管三尖瓣置换术的围术期预后效果观察  

Efficacy observation of perioperative prognosis in patients with severe tricuspid regurgitation after transcatheter tricuspid valve replacement

作　　者：左茜 翟蒙恩 苏洁 毛予 金屏 刘洋 杨剑 ZUO Qian;ZHAI Meng en;SU Jie;MAO Yu;JIN Ping;LIU Yang;YANG Jian(Department of Cardiovascular Surgery,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]空军军医大学西京医院心血管外科,陕西西安710032

出　　处：《空军军医大学学报》2023年第8期729-733,共5页Journal of Air Force Medical University

基　　金：国家自然科学基金(82000373)。

摘　　要：目的探讨重度三尖瓣反流(TR)患者行经导管三尖瓣置换术(TTVR)的围术期预后效果。方法对2020年9月至2022年8月空军军医大学西京医院心血管外科手术风险高危的重度及以上TR患者(10例)进行回顾性分析。在全身麻醉下,所有患者均行经心房手术入路,术中经食管超声心动图(TEE)和X射线引导下植入LuX-Valve。收集患者的术前、出院前以及术后6个月随访的临床资料进行分析。结果10例患者均成功植入LuX-Valve。手术时间140.0(120.0,172.5)min,ICU住院时间3.0(2.0,3.5)d。植入后,9例患者术中TEE无/微量瓣周漏,1例患者轻度瓣周漏,所有患者未发生其他围术期并发症。6个月随访结果显示,纽约心脏协会心功能Ⅱ级患者数量多于术前(8 vs 0,P<0.01),三尖瓣环平面收缩位移显著改善[16.4(14.1,18.0)mm vs 12.5(11.5,15.0)mm,P<0.01]。此外,患者6 min步行距离[360.0(315.0,390.0)m vs 212.5(165.0,255.0)m]以及堪萨斯城心肌病问卷评分[62(60,65)分vs 31(27,37)分]均较术前明显提高(P<0.01)。结论本研究初步证实使用LuX-Valve进行TTVR治疗严重TR患者是一种可行且相对安全的方法,临床结果可靠。然而,由于该手术难度较大,因此需要加强病情观察和严密监护。Objective To investigate the perioperative prognostic effect of transcatheter tricuspid valve replacement(TTVR)in patients with severe tricuspid regurgitation(TR).Methods A retrospective analysis was performed on 10 patients with severe/extremely severe TR at high surgical risk in Department of Cardiovascular Surgery,Xijing Hospital,Air Force Medical University from September 2020 to August 2022.Under general anesthesia,all patients underwent a transatrial surgical approach,with intraoperative transesophageal echocardiography(TEE)and X-ray guided implantation of LuX-Valve.The clinical data of patients before surgery,before discharge and 6 months after surgery were collected and analyzed.Results LuX-Valve was successfully implanted in all the 10 patients.The operation time was 140.0(120.0,172.5)min,and the ICU stay time was 3.0(2.0,3.5)d.After implantation,9 patients had no or minimal paravalvular leakage,1 patient had mild perivalvular leakage,and no other perioperative complications occurred in all patients.The results of 6-month follow-up showed that the number of patients with New York Heart Association functional Class II was higher than that before surgery(8 vs 0,P<0.01),and tricuspid annular plane systolic excursion was significantly improved[16.4(14.1,18.0)mm vs 12.5(11.5,15.0)mm,P<0.01].In addition,the 6-min walking distance of all patients[360.0(315.0,390.0)m vs 212.5(165.0,255.0)m]and Kansas City Cardiomyopathy Questionnaire score[62(60,65)points vs 31(27,37)points]were significantly higher than those before surgery(P<0.01).Conclusion This study preliminarily confirms that the use of LuX-Valve for TTVR in patients with severe TR is a feasible and relatively safe approach,with reliable clinical outcomes.However,due to the difficulty of the surgery,intensive observation and close monitoring are required.

关 键 词：三尖瓣反流 经导管三尖瓣置换术 预后 LuX-Valve 

分 类 号：R654.2[医药卫生—外科学]