二尖瓣置换术患者同期行非环三尖瓣成形的远期效果

Long-term outcomes of patients with mitral replacement and suture tricuspid annuloplasty

目的评价采用非环的三尖瓣成形技术的远期临床结果。方法纳入2006年1月至2011年3月我们施行的机械瓣二尖瓣置换且同期行三尖瓣成形术并完成了术后≥5年超声心动图复查的患者401例,其中女309例、男92例,年龄17~71(46.2±12.0)岁;窦性心率66例、心房扑动2例、心房颤动333例,心功能分级(NYHA)Ⅱ级19例、Ⅲ级380例、Ⅳ级2例。三尖瓣成形根据患者具体情况行瓣叶修补、二瓣化(bicuspidization)和改良Kay成形术。结果本组患者术后随访5~10(7.4±1.4)年。与术前相比,患者术后远期右心房[RA,(57.6±13.0)mm vs.(49.3±13.2)mm]、右心室[RV,(23.2±4.7)mm vs.(22.0±3.6)mm]、左心房[LA,(59.7±19.0)mm vs.(53.6±14.7)mm]及左心室[LV,(49.3±8.6)mm vs.(47.7±6.2)mm]均明显缩小,差异有统计学意义(P<0.01)。与术前相比,术后远期患者左心室射血分数(LVEF,60.3%±8.9%vs.61.7%±8.3%)及左心室缩短分数(LVFS,32.6%±6.3%vs.33.8%±5.5%)均明显增加,差异有统计学意义(P<0.01)。与术前相比,术后远期患者三尖瓣瓣环舒张期末内径[TEDD,(35.9±5.7)mm vs.(32.8±5.9)mm]、三尖瓣瓣环收缩期末内径[TESD,(9.4±5.7)mm vs.(26.5±4.9)mm]均明显缩小,差异有统计学意义(P<0.01)。与术前相比,术后远期患者三尖瓣反流(TR)构成比明显改善,差异有统计学意义(P<0.01)。结论二尖瓣病变患者以三尖瓣瓣环径作为同期行三尖瓣成形的手术指征是合理的,采用非环联合的个体化三尖瓣成形术同样可获得较好的远期结果,此外对患者术后TR应积极给予口服利尿剂。

Objective To evaluate long-term clinical results in patients who underwent mitral valve replacement and suture tricuspid annuloplasty. Methods We included 401 patients who underwent mitral valve replacement and suture tricuspid annuloplasty in our hospital between January 2006 and March 2011. There were 309 females and 92 males at age of 17-71 （46.2＋12.0） years. All patients were investigated by echocardiography at postoperative 5 years. The tricuspid valve procedures consisted of bicuspidization, modified Kay annuloplasty and leaflet repair according to the actual conditions. Results The patients were followed up for 5-10 （7.4＋1.4） years. As compared with preoperation, the right atrium （RA, 7.6＋13.0 mm vs. 49.3＋13.2 mm）, right ventrium （RV, 23.2＋4.7 mm vs. 22.0±3.6 mm）, left atrium （LA, 59.7±19.0 mm vs. 53.6±14.7 mm, left ventrium （LV, 49.3±8.6 mm vs. 47.7±6.2 mm）, tricuspid of end-distolic diameters （TEDD, 35.9±5.7 mm vs. 32.8±5.9 mm） and tricuspid of end-systolic diameters （TESD, 9.4±5.7 mm vs. 26.5±4.9 mm） of patients decreased significantly at postoperation （P〈0.01）. As compared with preoperation, left ventricular ejection fraction （LVEF, 60.3%±8.9% vs. 61.7%±8.3%） and left ventricular fractional shortening （LVFS, 32.6%±6.3% vs. 33.8%±5.5%） raised significantly at postoperation （P〈0.01）. As compared with preoperation, the constituent rate of tricuspid regurgitation （TR） improved significantly at postoperation （P〈0.01）. Conclusion Tricuspid annuloplasty adopting TEDD as a surgical indication is reasonable for patients with mitral diseases. Combined and individualized suture tricuspid annuloplasty can obtain better long-term results. It is needed to order aggressive diuretics treatment for patients with postoperative TR.