简化Manipal法三尖瓣成形术

The analysis of outcome of modified Manipal tricuspid annuloplasty

目的对比分析简化 Manipal 法三尖瓣成形术和 DeVega 法瓣环成形术的效果。方法2001年10月至2004年8月期间连续123例左心瓣膜手术(二尖瓣或二尖瓣主动脉瓣双瓣膜置换)同时行简化 Manipal 法三尖瓣成形者(A 组),与同期174例 DeVega 法三尖瓣成形者(对照组,B 组)进行三尖瓣成形术疗效对比分析。两组病例术前基本情况差异无统计学意义。结果术后早期死亡11例(A 组4例,B 组7例),总手术死亡率为3.7%。生存出院286例中,215例随访13～49个月,平均(28.4±9.1)个月,总随访率75.2%。随访期内死亡10例,晚期病死率4.7%。A 组在随访18个月、30个月、42个月时间段组内相互比较,3～4级三尖瓣关闭不全病人数量差异无统计学意义;而 B 组在同样时间段组内相互比较,3～4级三尖瓣关闭不全病人数量随时间增加而有所增加,差异有统计学意义(P<0.001)。随访期内 B 组有2例重度三尖瓣不全,内科治疗无效,分别于手术后1.5年、3.5年行三尖瓣置换术。结论随访结果显示简化 Manipal 法较 DeVega 法的成形效果更为稳定。

Objective To analyze comparatively the outcome of modified Manipal and DeVega tricuspid annuloplasty. Methods From Oct. 2001 to Aug. 2004, the consecutive 123 patients operated with modified Manipal tricuspid annuloplasty for tricuspid regurgitatlou at the time of left cardiac valve replacement （group A） were elected in this study. The other 174 patients operated with De Vega tricuspid annuloplasty at the time of left cardiac valve replacment were deeted randomly for control （group B）. There were no significant differences of the patient data before surgery between two groups. Results There were overall 11 early deaths （4 in group A, 7 in group B）, The overall in-hospital mortality rate was 3.7%. 215 of the 286 surviving patients were followed; the overall follow up was 75.2%. Mean follow-up was （28.4 ± 9.1） months （range from 13 to 49 months）. There were ten late deaths and the late mortality rate was 4.7%. There was no significant differences in the patients with 3 ＋ - 4 ＋ tricuspid regurgitation at follow-up 18, 30 and 42 months in group A; but there was an increase of the patients with 3 ＋ - 4 ＋ tricuspid regurgitation with an incremental follow up term in group B（ P 〈 0.1301 ）. Two patients with severe tricuspid regurgitation failed to respond to medical treatment in group B un- derwent tricuspid valve replacement at the 1.5-year and 3.5-year respectively in the follow-up term. Conclusion The remdts of follow-up demonstrated a mere stable effect of modified Manipal tricuspid annuloplasty.