三尖瓣成形治疗功能性三尖瓣反流的疗效及残留或复发的危险因素

Efficacy of tricuspid annuloplasty for functional tricuspid regurgitation and risk factors for residual or relapseam

探讨并对比三尖瓣人工瓣环和缝线成形治疗重度功能性三尖瓣反流(FTR)的近中期疗效,分析术后残留或复发的危险因素。方法:回顾性分析2014年1月-2018年1月广西医科大学第一附属医院收治的需同期行风湿性心脏病左心瓣膜置换术及三尖瓣成形(TVP)的91例患者,分为人工瓣环成形组(53例)和缝线成形组(38例)。收集患者的相关资料及术前、术后2周、术后3个月、术后6个月、术后6~12个月经胸超声心动图(TTE)数据,比较各时点各测值的变化以及术后重度三尖瓣反流免除率,探索TVP术后重度三尖瓣反流残留或复发的危险因素。结果:两组患者术后右房横径(RAD)、右室内径(RVD)、左房横径(LAD)均较术前明显减小,三尖瓣反流较术前显著减少,肺动脉收缩压(SPAP)明显降低,左室射血分数(LVEF)较术前改善,均差异有统计学意义(均P<0.05);左室内径(LVD)无显著差异。其中术后6个月RAD较术后3个月显著增大(P=0.007),术后6个月LAD较术后2周显著增大(P=0.036)。两组术后近中期重度三尖瓣反流免除率无显著差异(P=0.133)。Cox回归模型多因素分析显示,术前RAD、术后6~12个月SPAP>45 mmHg(1 mmHg=0.133 kPa)、缝线成形是TVP术后三尖瓣反流残留或复发的独立危险因素。结论:左心瓣膜置换术同期行TVP治疗重度FTR疗效确切,两种成形方式近中期疗效相仿,术前RAD、术后6~12个月SPAP>45 mmHg、缝线成形是TVP术后三尖瓣反流残留或复发的独立危险因素。

Objective:To explore the short-to-medium-term efficacy of suture or ring tricuspid annuloplasty for severe functional tricuspid regurgitation(FTR),to compare the efficacy of the two modalities and to analyze the risk factors of residual or recurrence after surgery.Method:A total of 91 patients who underwent tricuspid valvuloplasty(TVP)at the time of rheumatic left heart valve replacement surgery from January 2014 to January 2018 in the First Affiliated Hospital of Guangxi Medical University were included into the retrospective analysis.All patients were divided into the prosthetic ring annuloplasty group(n=53)and the suture annuloplasty group(n=38).Relevant general data and transthoracic echocardiographic data before and 2 weeks,3 months,6 months,and 6 to 12 months after surgery were collected.The changes of measured values at different time points,and the freedom from severe tricuspid regurgitation were compared to explore the risk factors of severe tricuspid regurgitation residual or recurrence after TVP.Result:Postoperative right atrium diameter(RAD),right ventricle diameter(RVD),left atrium diameter(LAD),tricuspid regurgitation,and systolic pulmonary artery pressure(SPAP)in the two groups were significantly decreased and left ventricular ejection fraction(LVEF)was improved compared with preoperative data,the differences were statistically significant(all P<0.05),but there was no significant difference in left ventricular diameter(LVD).RAD 6 months after operation increased significantly compared with 3 months after operation(P=0.007),and LAD 6 months after operation increased significantly compared with 2 weeks after operation(P=0.036).There was no significant difference of the freedom from severe tricuspid regurgitation in short-to-medium-term between the two groups(P=0.133).Multivariate analysis of the Cox regression model showed that preoperative RAD,SPAP>45 mmHg from 6 to 12 months after surgery,and suture plasty were independent risk factors for residual or recurrent of tricuspid regurgitation after TVP.Conclusion:TVP is effective in the treatment of severe FTR during left-sided valve replacement surgery,and the short-to-medium-term efficacy of the two modalities is similar.Preoperative RAD,SPAP>45 mmHg from 6 to 12 months after surgery,suture plasty are independent risk factors for residual or recurrent of tricuspid regurgitation after surgery.