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论文摘要

二尖瓣置换术同期行三尖瓣成形术临床疗效的术后5年评估

作者:许超, 钱永军, 唐红, 肖锡俊

Author:, , ,

收稿日期:2018-10-17          年卷(期)页码:2019,50(3):448-451

期刊名称:四川大学学报(医学版)

Journal Name:JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCE EDITION)

关键字:三尖瓣成形术, 三尖瓣反流, 超声心动图, 结果

Key words:, , ,

基金项目:

中文摘要

目的 探讨二尖瓣置换术合并轻度三尖瓣反流者同期行三尖瓣成形术,对术后5年的三尖瓣反流程度、三尖瓣环径和右侧心腔的结构与功能的影响。 方法 纳入2012年4~11月在四川大学华西医院行二尖瓣置换手术的患者36例,随机分配到两组:三尖瓣成形(TAP)组(n=18,缝合三尖瓣);三尖瓣非成形(nTAP)组(n=18,不干预三尖瓣),随访5年。行超声心动图检查,比较两组术前和术后5年的三尖瓣反流程度、三尖瓣环径和右侧心腔的结构与功能,收集和比较其余临床指标。 结果 TAP组男性7例, 女性11例, 平均年龄(45.7±12.5)岁;nTAP组男性6例,女性12例,平均年龄(45.4±10.5)岁。两组性别比、年龄、瓣膜病变类型差异无统计学意义,术前纽约心功能指数、超声心动图参数差异无统计学意义。瓣膜病因均为风湿性瓣膜病。手术时间、体外转流时间和术后住ICU时间两组差异无统计学意义。两组术前三尖瓣反流均为1级。术后5年,两组间临床、超声心动图参数、三尖瓣0~4级反流构成比差异均无统计学意义。术后5年,TAP组和nTAP组2~4级三尖瓣反流分别为3例(16.7%)、6例(33.3%)。术后5年的舒张期三尖瓣环径与术前比较,TAP组减小[(32.6±3.5) mm vs. (35.6±4.7) mm,P<0.05]。nTAP组有扩大趋势[(34.9±2.7) mm vs. (32.7±3.6) mm],但差异无统计学意义。与术前相比,术后5年两组的右侧心腔结构和功能参数均有改善(P<0.05)。 结论 二尖瓣置换手术时,同期对轻度三尖瓣反流形三尖瓣成形术,可改善右侧心腔结构和功能,缩小三尖瓣环径,或可降低术后5年中-重度三尖瓣反流的风险。

英文摘要

[1]

RODES-CABAU J, TARAMASSO M, O'GARA PT. Diagnosis and treatment of tricuspid valve disease: current and future perspectives. Lancet,2016,388(10058): 2431–2442. doi:10.1016/S0140-6736(16)00740-6

[2]

DAVID TE, DAVID CM, FAN CPS,et al. Tricuspid regurgitation is uncommon after mitral valve repair for degenerative diseases. J Thorac Cardiovasc Surg,2017,154(1): 110–122. doi:10.1016/j.jtcvs.2016.12.046

[3]

KARA I, KOKSAL C, ERKIN A,et al. Outcomes of mild to moderate functional tricuspid regurgitation in patients undergoing mitral valve operations: a meta-analysis of 2,488 patients. Ann Thorac Surg,2015,100(6): 2398–2407. doi:10.1016/j.athoracsur.2015.07.024

[4]

FALK V, BAUMGARTNER H, BAX JJ,et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg,2017,52(4): 616–664. doi:10.1093/ejcts/ezx324

[5]

李永波, 唐红, 梁春水, 等. 三尖瓣瓣环扩张伴轻度反流的二尖瓣置换术患者同期行三尖瓣成形术的随机对照试验. 中国胸心血管外科临床杂志,2015,22(6): 518–525.

[6]

DREYFUS GD, CORBI PJ, CHAN J,et al. Secondary tricuspid regurgitation or dilatation: Which should be the criteria for surgical repair?. Ann Thorac Surg,2005,79(1): 127–132. doi:10.1016/j.athoracsur.2004.06.057

[7]

ZHU TY, MENG X, HAN J,et al. An alternative intraoperative method based on annular circumference for the decision-making of prophylactic tricuspid annuloplasty. J Heart Valve Dis,2014,23(3): 370–376.

[8]

DWIVEDI G, MAHADEVAN G, JIMENEZ D,et al. Reference values for mitral and tricuspid annular dimensions using two-dimensional echocardiography. Echo Res Pract,2014,1(2): 43–50. doi:10.1530/ERP-14-0050

[9]

BENEDETTO U, MELINA G, ANGELONI E,et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg,2012,143(3): 632–638. doi:10.1016/j.jtcvs.2011.12.006

[10]

肖锡俊, 邓云丹, 钱永军, 等. 二尖瓣置换术患者同期行非环三尖瓣成形的远期效果. 中国胸心血管外科临床杂志,2017,24(9): 692–695.

[11]

GHANTA RK, CHEN R, NARAYANASAMY N,et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: m idterm results of 237 consecutive patients. J Thorac Cardiovasc Surg,2007,133(1): 117–126. doi:10.1016/j.jtcvs.2006.08.068

[12]

BERTRAND PB, KOPPERS G, VERBRUGGE FH,et al. Tricuspid annuloplasty concomitant with mitral valve surgery: effects on right ventricular remodeling. J Thorac Cardiovasc Surg,2014,147(4): 1256–1264. doi:10.1016/j.jtcvs.2013.05.007

[13]

VAN DE VEIRE NR, BRAUN J, DELGADO V,et al. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg,2011,141(6): 1431–1439. doi:10.1016/j.jtcvs.2010.05.050

[14]

CHIKWE J, ITAGAKI S, ANYANWU A,et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. JACC,2015,65(18): 1931–1938. doi:10.1016/j.jacc.2015.01.059

[15]

WANG J, HAN J, LI Y, et al. Impact of Surgical ablation of atrial fibrillation on the progression of tricuspid regurgitation and right-sided heart remodeling after mitral-valve surgery: a propensity-score matching analysis. JAHA, 2016, 5(12): e004213[2018-12-02]. https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5210400/. doi:10.1161/jaha.116.004213.

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