同期三尖瓣成形与单纯封堵治疗房间隔缺损合并继发性中重度三尖瓣关闭不全的倾向性评分匹配研究

Additional tricuspid valve annuloplasty versus isolated closure for atrial septal defect with secondary moderate to severe tricuspid regurgitation:A propensity score matching study

目的比较外科同期三尖瓣成形与单纯介入封堵治疗房间隔缺损(atrial septal defect,ASD)合并中重度三尖瓣关闭不全的效果。方法回顾性分析2009年1月—2020年6月广东省人民医院ASD合并继发性中重度三尖瓣关闭不全患者的临床资料。根据是否同期行三尖瓣成形术将患者分为成形组和非成形组。对两组患者基线资料进行1∶1倾向性评分匹配。结果257例患者中共32对成功匹配。成形组女24例、男8例,平均年龄(44.0±13.1)岁;非成形组女28例、男4例,平均年龄(44.5±11.6)岁。随访时两组患者的三尖瓣反流面积均较术前显著减少(P均<0.001),估测肺动脉压显著降低(P均<0.001)。与非成形组相比,成形组的三尖瓣反流面积减少更多(P=0.001)、估测肺动脉压降低更明显(P=0.002)。线性回归分析显示,年龄、术前三尖瓣反流面积与随访时三尖瓣反流面积呈正相关(β=0.045、0.259,P均<0.05),而同期三尖瓣成形与随访时三尖瓣反流面积呈负相关(β=–1.542,P=0.001)。结论同期三尖瓣成形可显著减少三尖瓣反流面积及降低肺动脉压,年龄大、术前严重三尖瓣关闭不全的患者应积极行三尖瓣成形。

Objective To compare the efficacy of additional tricuspid valve annuloplasty(TVP)and isolated closure for atrial septal defect(ASD)with moderate to severe tricuspid regurgitation(TR).Methods Clinical data of the patients diagnosed with ASD combined with secondary moderate to severe TR and treated in our hospital from January 2009 to June 2020 were retrospectively analyzed.Patients were divided into a TVP group and a non-TVP group based on whether TVP was performed simultaneously.The baseline data of two groups were matched with a ratio of 1∶1 propensity score.Results A total of 32 pairs from 257 patients were successfully matched.In the TVP group,there were 24 females and 8 males with an average age of 44.0±13.1 years.In the non-TVP group,there were 28 females and 4 males with an average age of 44.5±11.6 years.The TR area and estimated pulmonary artery pressure in the two groups were significantly decreased compared with preoperation(all P<0.001).The TR area(P=0.001)and the estimated pulmonary artery pressure(P=0.002)were decreased more significantly in the TVP group than those in the non-TVP group.Linear regression analysis showed that age and preoperative TR area had a positive correlation with TR area at follow-up(β=0.045 and 0.259,respectively,both P<0.05),while additional TVP had a negative correlation(β=–1.542,P=0.001).Conclusion Additional TVP can significantly reduce the TR area and pulmonary artery pressure,and elderly patients with severe TR before surgery should actively receive TVP.