三尖瓣置换手术的经验与结局

Associated experience and outcome of tricuspid valve replacement surgery

目的总结三尖瓣置换手术的经验与结局。方法回顾性分析2010年1月至2012年12月63例在首都医科大学附属北京安贞医院接受三尖瓣置换术患者的临床资料,根据手术效果进行经验总结。结果 3例患者围术期死亡,病死率4.8%。随访患者58例,随访时间(42.5±5.5)个月;随访期间2例患者在术后8个月和11个月发生瓣膜毁损,经再次置换瓣膜后因并发右心功能衰竭死亡,1例患者因心律失常死亡,1例患者因急性瓣膜功能障碍死亡;剩余54例患者心功能各项指标均良好,超声心动图检查显示瓣膜功能良好,生存质量得到明显改善。结论加强三尖瓣病变患者的随访,严格把握手术指征和手术时机,加强对围术期相关危险因素的认识,三尖瓣置换术可取得良好的临床疗效。

Objectives To summarize the associated experience and outcome of tricuspid valve replacement surgery. Methods Totally 63 patients with tricuspid valve replacement surgery who came from Beijing Anzhen Hospital Affiliated to Capital Medical University from January 2010 to December 2012 were reviewed. According to the results of surgery , experience of the surgery was summarized. Results Three patients died during perioperative period and the proportion was 4.8%. Fifty eight patients were followed up,duration of follow-up was（42.5±5.5）months. During the follow-up, 2 patients had valve damage at 8 and 11 months and died after valve replacement due to right heart failure：1 patient died due to cardiac arrhythmia;1 patient died due to acute valvular dysfunction. Cardiac function indicators were favorable,valve functions were good indicated by echocardiography and qualities of life were improved in the remaining 54 patients during follow-up. Conclusions Tricuspid valve replacement surgery can achieve good clinical efficacy ,if follow-up is strengthened ,surgical indications and appropriate timing of surgery are strictly grasped and related perioperative risk factors of awareness are enhanced.