三尖瓣成形术与置换术治疗合并右心衰竭的中重度三尖瓣关闭不全的效果分析

Efficacies of tricuspid valve replacement versus repair for moderate-to-severe tricuspid regurgitation with right heart failure

目的 比较三尖瓣成形术与置换术治疗合并右心衰竭的中重度三尖瓣关闭不全的效果.方法 回顾性分析2003年1月至2008年6月在天津市胸科医院因右心衰竭行三尖瓣手术治疗的患者228例,其中127例患者行三尖瓣成形术（三尖瓣成形组）,101例患者行三尖瓣置换术（三尖瓣置换组）.收集围手术期资料,并随访65个月,分析和评价两种手术方法治疗合并右心衰竭的三尖瓣关闭不全的效果.结果 三尖瓣成形组术前肝功能异常率、平均肺动脉收缩压均低于三尖瓣置换组术（P =0.023、0.033）.三尖瓣置换组患者平均主动脉阻断时间、体外循环时间、呼吸机辅助时间及重症监护病房（ICU）停留时间、正性肌力药物使用量明显高于三尖瓣成形组患者（P＜0.01）;三尖瓣成形组早期并发症率（15.8％与27.3％,P=0.042）、病死率（6.3％与16.8％,P=0.011）低于三尖瓣置换组.长期随访发现三尖瓣置换组患者三尖瓣血栓率高于三尖瓣成形组（P=0.036）;三尖瓣成形组患者三尖瓣中重度反流复发率高于三尖瓣置换组（28.7％与8.8％,P＜0.05）;三尖瓣成形组患者术后3个月、1、3、5年生存率高于三尖瓣置换组,但差异无统计学意义（P =0.231、0.089、0.133、0.078）.结论 在合并右心衰竭的三尖瓣关闭不全患者治疗中,三尖瓣成形术早期治疗效果优于三尖瓣置换术,而术后中期三尖瓣中重度反流复发率高于三尖瓣置换术。

Objective To compare the efficacies of tricuspid valve replacement versus plasty for moderate-to-severe tricuspid regurgitation with right heart failure.Methods From January 2003 to June 2008,a total of 228 patients with right heart failure undergoing tricuspid valve operations were selected.And the procedures included tricuspid valve plasty （n =127） and tricuspid valve replacement （n =101）.During a follow-up period of 65 months,their perioperative data were collected to evaluate the surgical outcomes.Results The abnormal liver function rate and average pulmonary artery systolic pressure in tricuspid valve plasty group were lower than those in tricuspid valve replacement group （P =0.023,0.033）.In replacement group,average aortic cross-clamping time,cardiopulmonary bypass time,ventilation time and stay length of intensive care unit （ICU）,the usage of inotropic drug was significantly higher than repair group （P〈0.01）.The early complication rate （15.8%） and case fatality rate （6.3%） of repair group were much lower than those of replacement group （27.3%,16.8%） （P =0.042,0.011）.Long-term follow-ups revealed that the tricuspid valve thrombosis rate in replacement group was higher than that in repair group （P =0.036）.And the recurrence rate of moderate-to-severe tricuspid regurgitation in repair group was higher than that in replacement group （28.7% vs 8.8%） （P =0.011）.The survival rate of patients in repair group was much higher than that of replacement group at 3 months,1,3,5 years postoperation.However,the differences were not statistically significant （P =0.231,0.089,0.133,0.078）.Conclusion For moderate-to-severe tricuspid regurgitation leading to right heart failure,the early efficacy of tricuspid valve plasty is much better than that of tricuspid valve replacement.The mid-term recurrence rate after tricuspid valve repair is higher than that of replacement.