基于倾向性得分匹配对心包软环成形术治疗功能性三尖瓣关闭不全的疗效研究

Analysis of the efficacy of adjustable pericardial soft annulus plasty in the treatment of functional tricuspid regurgitation secondary to rheumatic heart disease

目的比较心包软环三尖瓣成形术与DeVega成形术、人工瓣环成形术的手术疗效。方法回顾性分析因风湿性心脏病合并功能性三尖瓣关闭不全行三尖瓣成形术的227例患者临床资料,按三尖瓣成形术分成3组动态队列:心包环组(89例)、人工瓣环组(61例)、DeVega组(77例),分别进行1∶1倾向性得分匹配(匹配A:心包环组与人工瓣环组,匹配B:心包环组与DeVega组),成功匹配后纳入随访和资料收集,随访过程中临床资料不完整的患者按匹配情况成对移出研究队列。比较术后1、6、24个月的随访结果。结果术后1个月各组的三尖瓣反流均较术前明显减少甚至消失,右心房及右心室也较术前缩小,差异有统计学意义(P<0.05)。术后6个月各组的三尖瓣反流面积、右心房/室内径与术后1个月的结果对比,差异无统计学意义(P>0.05),三尖瓣反流复发率各组之间差异无统计学意义(P>0.05)。术后24个月匹配A中的两组在三尖瓣反流复发率、三尖瓣反流面积、右心房/室内径的差异均无统计学意义(P>0.05);匹配B中的心包环组与Devega组的右心房/室内径的差异无统计学意义,但Devega组术后24个月的三尖瓣反流面积较术后1个月增多,差异有统计学意义(P<0.05),且三尖瓣反流面积及复发率均显著高于心包环组(P<0.05)。结论心包软环三尖瓣成形术能够有效纠正功能性三尖瓣关闭不全,使右心逆重构,是一种疗效确切的三尖瓣成形术式。

Objective To compare the surgical efficacy of pericardial soft ring tricuspid valvuloplasty with DeVega and artificial valvuloplasty.Methods 227 patients undergoing tricuspid valvuloplasty due to rheumatic heart disease complicated with functional tricuspid valve insufficiency were retrospectively analyzed and divided into 3 groups according to tricuspid valvuloplasty dynamic cohort(pericardial ring group,89 cases;the artificial flap ring group,61 cases,and the DeVega group,77 cases)were matched 1∶1 for propensity score(match A:pericardial ring group and artificial flap ring group;match B:pericardial ring group and DeVega group),the successful matching was included in follow-up and data collection,and cases with incomplete case data during follow-up were removed from the study cohort in pairs according to matching conditions.The results of follow-up 1 month,6 months and 24 months after surgery were compared.Results 1 month after operation:the tricuspid valve regurgitant in all groups was significantly reduced or even disappeared compared with that before operation,and the right atrium and right ventricle were also smaller than that before operation,with statistical significance(P<0.05).6 months after surgery:There was no statistical significance in the area of tricuspid regurgitation and right atrial/indoor diameter between all groups compared with the results one month after surgery(P>0.05),and there was no statistical significance in the recurrence rate of tricuspid regurgitation between all groups(P>0.05).24 months after surgery:There were no significant differences in the recurrence rate of tricuspid regurgitation,area of tricuspid regurgitation and right atrial/indoor diameter between the two groups in matching A(P>0.05).There was no statistical significance in the right atrial/indoor diameter between the matched pericardial ring group and the Devega group,but the tricuspid valve regurgentation area of the Devega group at 24 months after surgery was higher than that of the Devega group at 1 month after surgery,and the difference was statistically significant(P<0.05).The regurgitation area and recurrence rate of tricuspid valve were significantly higher than those of pericardium-TVP group(P<0.05).Conclusion Pericardial soft ring tricuspid valvuloplasty can effectively correct functional tricuspid valvuloplasty and reverse right heart remodeling,which is an effective tricuspid valvuloplasty.