左心系统瓣膜术后再次行三尖瓣手术的临床疗效分析

Clinical Effect of Tricuspid Valve Re-operation after Left Cardiac Valve Surgery

目的 探讨左心系统瓣膜手术后患者再次行三尖瓣手术的临床疗效。方法 回顾性分析2009年1月至2014年11月我院收治的再次行三尖瓣手术23例患者的临床及随访资料，男3例、女20例，年龄71～34 （53.48±10.79） 岁，平均体重指数（21.77±2.42） kg/m2。所有患者经电话及门诊随访3个月至5年。结果 所有手术均在体外循环下完成，经胸骨正中切口手术15例，经右前外侧第4肋间切口手术8例，平均手术时间（284.35±56.16） min，平均体外循环时间（138.61±46.91） min。住院期间死亡1例、自动出院2例，其他20例患者均顺利恢复出院。随访3个月至5年，1例患者因房室传导阻滞行永久起搏器治疗，3例患者因房性心律失常给予药物治疗，1例患者因左心系统人工瓣膜感染性心内膜炎再次住院手术，其他患者随访情况良好。此外，3例三尖瓣成形患者随访均为轻度反流。结论 左心系统瓣膜手术后，再次行三尖瓣手术可采用多种手术路径及策略，疗效确切、中期效果良好，但远期效果仍有待进一步随访。

Objective To evaluate the clinical efficacy of tricuspid valve re-operation after left cardiac valve surgery. Methods We retrospectively analyzed the clinical data of 23 patients underwent tricuspid valve re-operation in the Affiliated Drum Tower Hospital of Medical School, Nanjing University from January 2009 to November 2014. There were 3 males and 20 females with a mean age 53.48±10.79 years ranging from 34 to 71 years. The average body mass index of the 23 patients was 21.77±2.42 kg/m2. We followed up all the patients in outpatient department or through telephone for 3 months to 5 years. Results All surgeries were operated under cardiopulmonary bypass. There were 15 patients underwent operation through medisternal incision and 8 patients underwent operation through the fourth intercostal incision of right anterolateral side. The mean operation time was 284.35±56.16 minutes and the mean time of cardiopulmonary bypass was 138.61±46.91 minutes. One patient died postoperatively and 2 patients chose to discharge automatically after operation. The other 20 patients recovered and discharged uneventfully. We followed up the patients for 3 months to 5 years. One patient underwent permanent pacemaker therapy for atrioventricular block, 3 patients accepted pharmaceutical therapy for atrial arrhyttmia, 1 patient underwent re-operation for infectious endocarditis of left cardiac artificial valve. and the follow-up conditions of the rest patients were well. Besides, the follow-up data showed that there was a mild regurgitation in 3 patients underwent tricuspid valve plasty. Conclusion Tricuspid valve re-operationafter left cardiac valve surgery can take multiple surgical pathways and strategies. The clinical effect has been proved and the midterm follow-up condition is well, but we still need the long-term follow-up for the further effect.