三种三尖瓣成形术治疗三尖瓣返流近期疗效分析_《中国修复重建外科杂志》

作者：

方智 , 蒙炜 , 张尔永

四川大学华西医院心脏大血管外科（成都，610041）;

关键词：

三尖瓣反流瓣环成形术 Kay成形术 DeVega成形术

DOI：

10.7507/1002-1892.20130269

视频：

导出 下载 收藏 扫码 引用

摘要 全文 图表 视频 参考文献 施引文献 补充材料

目的比较3种三尖瓣成形术治疗三尖瓣反流术后近期反流程度的改善效果。方法2010年10 月－2011年6月，共纳入148例风湿性心脏病行左心瓣膜置换手术同期行三尖瓣成形术患者。男32例，女116例；年龄15～66岁，平均47.5岁。根据三尖瓣成形术不同将患者分为3组：Cosgrove-Edwards成形环组（成形环组）58例、Kay成形组（Kay组）61例、DeVega成形组（DeVega组）29例。术前3组除三尖瓣反流程度（成形环组重于其余2组）、房颤及行射频消融术比例（成形环组高于其余2组）比较差异有统计学意义（P lt; 0.05）外，其余一般资料比较差异均无统计学意义（P gt; 0.05），具有可比性。记录3组患者围手术期资料，根据纽约心脏病协会（NYHA）分级标准行心功能评价，心脏彩色超声多普勒检查记录围手术期及随访期间的三尖瓣反流程度。结果术后Kay组及成形环组各1例因发生低心排综合征死亡。Kay组和成形环组分别有2例和1例患者发生肺部感染，成形环组有1例术后胸骨哆开再次手术，3组患者围手术期并发症发生率比较差异无统计学意义（P=0.840）。出院时3组患者三尖瓣反流程度均较术前显著改善（P lt; 0.001）。146例患者获随访，随访时间6～12个月，平均7.3个月。末次随访时3组患者心功能NYHA分级较术前均有所提高（P lt; 0.001），但3组心功能改善程度差异无统计学意义（χ2=0.120，P=0.942）。末次随访时，3组患者反流程度较术前有所改善（P lt; 0.001），且3组改善程度差异有统计学意义（χ2=26.827，P=0.000），成形环组术后反流改善程度明显优于其余2组（P lt; 0.001），DeVega组与Kay组术后反流改善程度差异无统计学意义（Z=1.467，P=0.142）。结论采用三尖瓣软质成形环成形术治疗三尖瓣反流患者，其术后近期三尖瓣反流程度改善效果优于Kay成形术及DeVega成形术。

引用本文： 方智,蒙炜,张尔永. 三种三尖瓣成形术治疗三尖瓣返流近期疗效分析. 中国修复重建外科杂志, 2013, 27(10): 1230-1233. doi: 10.7507/1002-1892.20130269 复制

1.	Perier P, Jeserich M, Vieth M, et al. Mitral valve reconstruction in a patient with Libman-Sacks endocarditis: a case report. J Heart Valve Dis, 2011, 20(1): 103-106.
2.	Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
3.	Garatti A, Canziani A, Mossuto E, et al. Tricuspid valve replacement with mechanical prostheses: long-term results. J Heart Valve Dis, 2010, 19(2): 194-200.
4.	Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol, 2008, 33(2): 47-84.
5.	Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
6.	Singh SK, Tang GH, Maganti MD, et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg, 2006, 82(5): 1735-1741.
7.	许建屏, 潘世伟, 葛翼鹏. 三尖瓣改良DeVega环缩术与人工软环成形术效果比较. 中华胸心血管外科杂志, 2006, 22(2): 134-135.
8.	Carrier M, Pellerin M, Guertin MC, et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Valve Dis, 2004, 13(6): 952-956.
9.	Kim HK, Lee SP, Kim YJ, et al. Tricuspid regurgitation: clinical importance and its optimal surgical timing. J Cardiovasc Ultrasound, 2013, 21(1): 1-9.
10.	Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3): 632-638.
11.	Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
12.	胡佳, 康宁, 万松. 外科修复功能性三尖瓣反流: 旧课题的新认识. 中国胸心血管外科临床杂志, 2010, 17(6): 494-498.
13.	Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? J Thorae Cardiovasc Surg, 2010, 139(6): 1473-1482．.
14.	Khorsandi M, Banerjee A, Singh H, et al. Is a tricuspid annuloplastyring significantly better than a De Vega’s annuloplasty stitch when repairingsevere tricuspid regurgitation? Interact Cardiovasc Thorac Surg, 2012, 15(1): 129-135.
15.	Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15): e523-661.
16.	Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
17.	庞中一, 陆龙. 功能性三尖瓣反流的改良DeVega成形环缩术与经典DeVega环缩术疗效分析. 医学研究杂志, 2009, 38(4): 98-100.
18.	张嵬. 三尖瓣瓣环成形术临床研究现状. 河北北方学院学报: 医学版, 2008, 25(2): 77-80.

1. Perier P, Jeserich M, Vieth M, et al. Mitral valve reconstruction in a patient with Libman-Sacks endocarditis: a case report. J Heart Valve Dis, 2011, 20(1): 103-106.
2. Kim JB, Yoo DG, Kim GS, et al. Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes. Heart, 2012, 98(1): 24-30.
3. Garatti A, Canziani A, Mossuto E, et al. Tricuspid valve replacement with mechanical prostheses: long-term results. J Heart Valve Dis, 2010, 19(2): 194-200.
4. Shah PM, Raney AA. Tricuspid valve disease. Curr Probl Cardiol, 2008, 33(2): 47-84.
5. Colombo T, Russo C, Ciliberto GR, et al. Tricuspid regurgitation secondary to mitral valve disease: tricuspid annulus function as guide to tricuspid valve repair. Cardiovasc Surg, 2001, 9(4): 369-377.
6. Singh SK, Tang GH, Maganti MD, et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg, 2006, 82(5): 1735-1741.
7. 许建屏, 潘世伟, 葛翼鹏. 三尖瓣改良DeVega环缩术与人工软环成形术效果比较. 中华胸心血管外科杂志, 2006, 22(2): 134-135.
8. Carrier M, Pellerin M, Guertin MC, et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Valve Dis, 2004, 13(6): 952-956.
9. Kim HK, Lee SP, Kim YJ, et al. Tricuspid regurgitation: clinical importance and its optimal surgical timing. J Cardiovasc Ultrasound, 2013, 21(1): 1-9.
10. Benedetto U, Melina G, Angeloni E, et al. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2012, 143(3): 632-638.
11. Rogers JH, Bolling SF. The tricuspid valve: current perspective and evolving management of tricuspid regurgitation. Circulation, 2009, 119(20): 2718-2725.
12. 胡佳, 康宁, 万松. 外科修复功能性三尖瓣反流: 旧课题的新认识. 中国胸心血管外科临床杂志, 2010, 17(6): 494-498.
13. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: Annulus, commissure, or leaflet procedure? J Thorae Cardiovasc Surg, 2010, 139(6): 1473-1482．.
14. Khorsandi M, Banerjee A, Singh H, et al. Is a tricuspid annuloplastyring significantly better than a De Vega’s annuloplasty stitch when repairingsevere tricuspid regurgitation? Interact Cardiovasc Thorac Surg, 2012, 15(1): 129-135.
15. Bonow RO, Carabello BA, Chatterjee K, et al. 2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. Circulation, 2008, 118(15): e523-661.
16. Vahanian A, Alfieri O, Andreotti F, et al. Guidelines on the management of valvular heart disease (version 2012). Eur Heart J, 2012, 33(19): 2451-2496.
17. 庞中一, 陆龙. 功能性三尖瓣反流的改良DeVega成形环缩术与经典DeVega环缩术疗效分析. 医学研究杂志, 2009, 38(4): 98-100.
18. 张嵬. 三尖瓣瓣环成形术临床研究现状. 河北北方学院学报: 医学版, 2008, 25(2): 77-80.

《中国修复重建外科杂志》

三种三尖瓣成形术治疗三尖瓣返流近期疗效分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

《中国修复重建外科杂志》

三种三尖瓣成形术治疗三尖瓣返流近期疗效分析

摘要 全文 图表 视频 参考文献 施引文献 补充材料

上一篇

下一篇

Format

Content

摘要全文图表视频参考文献施引文献补充材料