Do Q B, Pellerin M, Carrier M, Cartier R, Hébert Y, Pagé P, Perrault L P, Pelletier L C
Montreal Heart Institute, Montreal, Canada.
Can J Cardiol. 2000 Apr;16(4):489-93.
To examine the early and late results of isolated tricuspid valve replacement (TVR).
All isolated TVRs performed at the Montreal Heart Institute, Montreal, Quebec between January 1978 and January 1998 were retrospectively reviewed. Follow-up data on patients were obtained through the valve clinic.
From a total of 79 TVR and 375 tricuspid annuloplasties performed during the study period, 29 patients who underwent 32 isolated TVRs (six mechanical valves and 26 bioprostheses) were included. Patient age ranged from 25 to 70 years (mean 48), and 62% were female. Twenty-seven patients (84%) were in New York Heart Association (NYHA) functional classes III and IV. Previous valve surgery had been performed in 22 patients (69%) among whom nine had undergone TVR.
Postoperatively, a permanent pacemaker was implanted in nine patients (28%), and reoperation because of bleeding was required in two patients. Mean follow-up was 67.7 months (93% complete). Serial echocardiography showed prosthesis dysfunction in three patients, requiring two valve re-replacements at 12.8 and 7.7 years after initial surgery. All patients, except three, showed an improvement of their NYHA class. Six patients (19%) died in hospital and seven patients died during late follow-up at a mean of 38.1 months after surgery, including one valve-related death (mechanical valve thrombosis). The actuarial survival rate of all patients was 63% after five years and 47% after 10 years.
Isolated TVR remains a high risk procedure. Most survivors, however, should expect a better quality of life by the improvement in their NYHA class.
研究单纯三尖瓣置换术（TVR）的早期和晚期结果。
对1978年1月至1998年1月在魁北克省蒙特利尔市蒙特利尔心脏研究所进行的所有单纯TVR手术进行回顾性研究。通过瓣膜门诊获取患者的随访数据。
在研究期间共进行了79例TVR手术和375例三尖瓣环成形术，其中29例患者接受了32次单纯TVR手术（6例使用机械瓣膜，26例使用生物瓣膜）。患者年龄在25至70岁之间（平均48岁），62%为女性。27例患者（84%）属于纽约心脏协会（NYHA）心功能Ⅲ级和Ⅳ级。22例患者（69%）曾接受过瓣膜手术，其中9例曾接受过TVR手术。
术后，9例患者（28%）植入了永久性起搏器，2例患者因出血需要再次手术。平均随访时间为67.7个月（93%的随访完整）。系列超声心动图显示3例患者出现人工瓣膜功能障碍，分别在初次手术后12.8年和7.7年需要进行2次瓣膜再次置换。除3例患者外，所有患者的NYHA心功能分级均有所改善。6例患者（19%）在住院期间死亡，7例患者在术后平均38.1个月的晚期随访期间死亡，其中包括1例瓣膜相关死亡（机械瓣膜血栓形成）。所有患者的5年精算生存率为63%，10年为47%。
单纯TVR仍然是一项高风险手术。然而，大多数幸存者有望通过NYHA心功能分级的改善获得更好的生活质量。
