经导管三尖瓣介入治疗术后并发症的围手术期管理

Perioperative management of complications after transcatheter tricuspid valve intervention

目的分析经导管三尖瓣介入治疗(TTVI)术后并发症的围手术期管理相关问题。方法回顾性纳入首都医科大学附属北京安贞医院瓣膜外科中心自2019年1月1日至2022年3月30日接受TTVI的三尖瓣关闭不全(TR)患者41例。收集患者临床资料,分析患者围手术期并发症发生及管理情况。结果41例患者均手术成功,麻醉时间2.3(2.0,10.3)h,机械辅助通气时间13.7(10.9,22.8)h,重症监护病房停留时间12.3(9.5,35.7)h。术后早期死亡3例,2例死于急性心功能不全,1例死于感染合并多器官功能衰竭。1例因术前心率慢已存在起搏器植入指征,术后予以植入永久起搏器,2例呼吸功能不全,2例术后心力衰竭,6例发生不同类型的心律失常,体外膜氧合设备植入2例,主动脉内球囊反搏1例,2例出现急性肾损伤行连续性肾脏替代治疗,轻中度瓣周漏7例,开胸探查1例,经及时处理和有效管理,除死亡患者外,余患者均恢复良好,顺利出院。结论对于TR患者而言,TTVI是一种安全、有效的治疗措施,针对其术后常见并发症进行密切观察及精准管理能够降低围手术期死亡率及并发症发生率,进而改善预后。

Objective To analyze the perioperative management of complications after transcatheter tricuspid valve intervention(TTVI).Methods Totally 41 patients with tricuspid valve regurgitation(TR)who received TTVI from Valve Surgery Center,Beijing Anzhen Hospital,Capital Medical University from January 1,2019 to March 30,2022 were retrospectively included.Clinical data of patients were collected,and the occurrence and management of perioperative complications in patients were analyzed.Results All the 41 patients underwent surgery successfully,with anesthesia time of 2.3(2.0,10.3)h,mechanical assisted ventilation time of 13.7(10.9,22.8)h,and intensive care unit stay time of 12.3(9.5,35.7)h.There were 3 early postoperative deaths,2 deaths from acute heart failure,and 1 death from infection combined with multiple organ failure.One patient had indications for pacemaker implantation due to slow heart rate before operation,and permanent pacemakers were implanted after operation,2 cases had respiratory dysfunction,2 cases had heart failure after operation,6 cases had different types of arrhythmia,2 cases had extracorporeal membrane oxygenation device implantation,1 case had intra aortic balloon counterpulsation,2 cases had acute renal injury and received continuous renal replacement treatment,7 cases had mild to moderate perivalvular leakage,and 1 case had open chest exploration.After timely treatment and effective management,except for dead patients,all patients recovered well and were discharged smoothly.Conclusions For TR patients,TTVI is a safe and effective treatment measure.Close observation and accurate management of common postoperative complications can reduce perioperative mortality and complications,and improve the prognosis.