成形环治疗三尖瓣关闭不全的疗效及复发因素分析

Risk factor and outcome of tricuspid annuloplasty with Annuloplasty ring for treating functional tricuspid regurgitation

目的总结应用成形环治疗功能性三尖瓣关闭不全(FTR)的治疗效果及术后复发危险因素分析。方法以简阳市人民医院心血管外科2012年10月至2015年12月在心脏瓣膜手术同期使用人工瓣环行三尖瓣成形术的124例患者为研究对象,进行单因素和多因素Logistic回归分析,找出影响三尖瓣成形术后复发三尖瓣反流(TR)的危险因素。结果全组患者随访2~5年,随访期末三尖瓣反流构成比明显改善,与术前比较差异有统计学意义(P<0.05)。单因素分析显示,术前纽约心脏协会心功能分级(NYHA)>3级、术前左心房前后径(LA)、术后右心房横径(RA)、术后右心室内径(RV)、合并心房颤动、瓣环类型、术前三尖瓣反流程度重、术后右心室缩短率与三尖瓣成形术后复发有关;经多因素Lgostic回归分析显示,术前左心房前后径>60mm、术前三尖瓣反流程度重、术后右心室缩短率是三尖瓣成形术后复发三尖瓣反流的独立危险因素。与传统的佰仁思硬环相比,MC3Edwards成形环能更有效地减少术后三尖瓣反流的发生。结论三尖瓣成形术后三尖瓣反流的发生与患者术前左心房前后径>60mm、术前三尖瓣反流程度重、术后右心室缩短率、瓣环类型有关。应用硬质成形环行三尖瓣成形治疗功能性三尖瓣关闭不全,近中期疗效好。

Objectives To analyze risk factors,clinical outcome of tricuspid annuloplasty with Rigid forming ring for the treatment of functional tricuspid regurgitation(TR)of people with rheumatic heart disease. Methods From October 2012 to December 2015,124 patients with rheumatic heart disease undergoing left-side heart valve replacement and concomitant tricuspid valvuloplasty with Rigid forming ring were included. Univariate and multivariate Logistic regression analysis were used to identify the risk factors of TR after tricuspid valvuloplasty surgery. Results All the patients were followed up for 2-5 years. The constitute of TR were improved significantly,and the difference was statistically when compared with that before surgery(P<0.05). Univariate risk factors analysis showed that New York Heart Association(NYHA)heart function class>3,preoperative left atrial(LA)anteroposterior diameter,postoperative right atrial transverse diameter(RA),postoperative right ventricular(RV)diameter,complicated atrial fibrillation, the Flap ring types,preoperative TR degree,postoperative right ventricular outflow tract shortening rate were related with recurrence of TR after tricuspid valve annuloplasty. Multivariate Logistic regression analysis showed that preoperative LA anteroposterior diameter>60 mm,and the degree of preoperative TR,postoperative right ventricular outflow tract shortening rate were independent risk factors. Compared with BaiRensi rigid forming ring,MC3 Edwards ring can better reduce the occurrence of TR after surgery. Conclusions The occurrence of TR after tricuspid valvuloplasty is related to preoperative LA anteroposterior diameter>60 mm, the degree of preoperative TR, postoperative right ventricular outflow tract shortening rate. The early and intermediate outcomes of tricuspid valvuloplasty with rigid forming ring for treatment of TR are satisfactory.