风湿性心脏病三瓣膜联合修复手术近中期结果分析  

Analysis of the results of triple valve repair for rheumatic heart disease

作　　者：刘周 张亚哲 姜文剑[1] 郝晓艳[1] 杨旭[1] 韩杰[1] 贡鸣[1] 张宏家[1] LIU Zhou;ZHANG Yazhe;JIANG Wenjian;HAO Xiaoyan;YANG Xu;HAN Jie;GONG Ming;ZHANG Hongjia(Valve Surgery Center,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心血管精准医学北京实验室瓣膜外科中心,100029

出　　处：《心肺血管病杂志》2023年第10期1023-1029,共7页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:分析风湿性心脏病(rheumatic heart disease,RHD)合并二尖瓣、主动脉瓣、三尖瓣病变患者,行三瓣膜联合修复手术的近、中期预后及手术技术可行性。方法:2015年1月到2022年8月,93例风湿性三瓣膜病变患者于本中心行三瓣膜联合修复手术。平均年龄54.7岁,其中女性61(65.6%)例,每位患者均有明显风湿性瓣膜病症状及体征。术前超声评估每位患者的3个瓣膜均有不同程度的狭窄或关闭不全病变,其中二尖瓣狭窄达到重度的患者有54(58.1%)例、关闭不全达到重度者有35(37.6%)例;主动脉瓣狭窄及关闭不全达重度者分别为2(2.2%)例和4(4.3%)例;三尖瓣关闭不全达重度的患者有19(20.4%)例。结果:术后随访4~96个月(中位随访时间39个月),98.9%患者完成了随访。住院期间无瓣膜相关并发症及死亡,随访期间全因死亡3例,术后5年生存率约为97.8%,5年免于重度瓣膜病变发生率约为94.6%,5年免于瓣膜相关并发症发生率约为95.3%。结论:RHD三瓣膜病变行联合修复手术在经验丰富的心脏中心具有一定的可行性,术后短中期死亡率及瓣膜不良事件发生率均较低,但远期存在一定的重度瓣膜病变风险。Objective:To analyze the short-term and medium-term prognosis and the feasibility of triple valve repair in patients with rheumatic heart disease complicated with mitral,aortic,and tricuspid valve diseases.Methods:Between January 2015 and August 2022,93 patients with rheumatic heart disease underwent triple valve repair surgery at our center.The mean age of the patients was 54.7 years,and 65.6%were women.Each patient had obvious symptoms of rheumatic heart disease,and preoperative echocardiography evaluation showed that each patient had stenosis or regurgitation of triple valves,including severe mitral stenosis(58.1%,n=54)and severe mitral regurgitation(37.6%,n=35);severe aortic stenosis(2.2%,n=2)and severe aortic regurgitation(4.3%,n=4);and severe tricuspid regurgitation(20.4%,n=19).Results:The follow-up period was from 4 months to 96 months(median follow-up was 39 months),with a completion rate of 98.9%.There were no valve-related complications or deaths during hospitalization.During the followup period,3 patients died,and the 5-year survival rate was 97.8%.The freedom from severe valvular disease and valve-related complications were about 94.6%and 95.3%,respectively,after 5 years.Conclusions:Simultaneous repair of triple valves in rheumatic heart disease is feasible in experienced centers,and the short and medium postoperative mortality and incidence of valve-related complications are low.However,there is a certain risk of severe valvular disease in the long term.

关 键 词：风湿性心脏病 三瓣膜手术 瓣膜修复 

分 类 号：R54[医药卫生—心血管疾病]