微创三尖瓣成形术与置换术治疗二尖瓣置换术后三尖瓣关闭不全的效果比较

Comparison of Effect of Minimally Invasive Tricuspid Valvuloplasty and Valve Replacement in the Treatment of Mitral Valve Insufficiency After Mitral Valve Replacement

目的探讨微创三尖瓣成形术与置换术治疗二尖瓣置换术后三尖瓣关闭不全的效果。方法选取河南省胸科医院2014年1月至2021年10月收治的50例二尖瓣机械瓣置换术后三尖瓣关闭不全患者,按照治疗方式分为三尖瓣置换术组(8例,接受三尖瓣瓣膜置换术)和三尖瓣成形术组(42例,接受三尖瓣成形术)。比较两组患者手术相关指标、心功能情况以及反流情况。结果三尖瓣成形术组术后体外循环时间、呼吸机使用时间及ICU滞留时间较三尖瓣置换术组短,术后24 h引流量与三尖瓣置换术组相比较少(P<0.05);两组手术时间比较差异无统计学意义(P>0.05);术后6个月,三尖瓣成形术组心功能恢复至Ⅰ级8例,Ⅱ级30例,Ⅲ级4例。三尖瓣成形术组心功能优于三尖瓣置换术组(P<0.05);随访6个月,三尖瓣成形术组三尖瓣轻度反流情况优于三尖瓣置换术组(P<0.05)。结论微创三尖瓣成形术是一种相对简单并安全的手术方式,可改善患者心功能,可作为二尖瓣机械瓣膜置换术后远期出现三尖瓣重度关闭不全的推荐治疗方式。

Objective To investigate the efficacy of minimally invasive tricuspid valvuloplasty and tricuspid valve replacement in the treatment of mitral valve insufficiency after mitral valve replacement.Methods Fifty patients with tricuspid insufficiency after mitral mechanical valve replacement admitted to Henan Provincial Chest Hospital from January 2014 to October 2021 were selected and divided into tricuspid valve replacement group(8 cases,received tricuspid valve replacement)and tricuspid valvuloplasty group(42 cases,received tricuspid valvuloplasty)according treating method.The surgery-related indexes,cardiac function and regurgitation in the two groups were compared.Results The postoperative extracorporeal circulation time,ventilator use time and ICU stay time were shorter in the tricuspid valvuloplasty group than those in the tricuspid valve replacement group,and less drainage at 24 hours postoperatively compared to the tricuspid valve replacement group(P<0.05).There was no statistical difference in operative time between the two groups(P>0.05).Six months after the operation,the cardiac function recovered to gradeⅠin 8 cases,gradeⅡin 30 cases and gradeⅢin 4 cases in the tricuspid valvuloplasty group.The cardiac function of the tricuspid valvuloplasty group was better than that of the tricuspid valve replacement group(P<0.05).At 6-month follow-up,the mild tricuspid regurgitation of the tricuspid valvuloplasty group was better than that of the tricuspid valve replacement group(P<0.05).Conclusion Minimally invasive right anterolateral incision cardiac nonstop treatment of tricuspid valve insufficiency after mitral mechanical valve replacement is a relatively simple and safe procedure,which can improve patients’cardiac function and can be the recommended treatment for severe tricuspid valve insufficiency that occurs in the distant future after mitral mechanical valve replacement.