De La Zerda David J, Cohen Oved, Marelli Daniel, Esmailian Fardad, Hekmat Diana, Laks Hillel
Division of Cardiac Surgery, David Geffen School of Medicine, Los Angeles, CA, USA.
Heart Surg Forum. 2008;11(1):E4-8. doi: 10.1532/HSF98.20071124.
Uncorrected functional tricuspid regurgitation can lead to long-term morbidity and mortality. To evaluate our results using autologous pericardium annuloplasty to treat tricuspid regurgitation, we retrospectively reviewed 59 consecutive adult patients aged 19 years to 83 years (58.7 +/- 15.5 years) who underwent tricuspid valve annuloplasty between 2000 and 2003. Concomitant procedures consisted of mitral valve surgery in 83% of patients, aortic valve surgery in 28%, coronary bypass in 31%, and atrial-septal defect correction in 28%. Annuloplasty was performed using a strip of pericardium treated in glutaraldehyde 0.6% for 10 min. Two rows of continuous horizontal mattress Gore-Tex sutures were used to secure the pericardium to the tricuspid annulus. Follow-up was performed in 100% of the patients, and the mean follow-up was 4.4 +/- 1.2 years (range, 2.4 to 7 years). Postoperative death within 30 days occurred in 1 of 59 patients (1.6%). None of the patients required reoperation related to tricuspid regurgitation or stenosis. The actuarial survival rate was 98.4% at 7 years after operation. Echocardiography was performed in 58 of 58 surviving patients (100%). Up to 7 years postoperatively, tricuspid regurgitation was trace in 67.2% of patients, mild in 31%, and moderate in 1.8%; there was no occurrence of severe regurgitation on follow-up. Our results indicate that autologous pericardium tricuspid annuloplasty is a useful procedure in patients with moderate or severe tricuspid regurgitation. This procedure provides a durable, reproducible annuloplasty of the tricuspid valve.
未经纠正的功能性三尖瓣反流可导致长期发病和死亡。为了评估我们使用自体心包环缩术治疗三尖瓣反流的结果，我们回顾性分析了2000年至2003年间连续接受三尖瓣环缩术的59例成年患者，年龄在19岁至83岁之间（平均年龄58.7±15.5岁）。同期手术包括83%的患者进行二尖瓣手术，28%的患者进行主动脉瓣手术，31%的患者进行冠状动脉搭桥手术，28%的患者进行房间隔缺损修补术。环缩术采用一条经0.6%戊二醛处理10分钟的心包条进行。使用两排连续的水平褥式 Gore-Tex缝线将心包固定于三尖瓣环。所有患者均进行了随访，平均随访时间为4.4±1.2年（范围为2.4至7年）。59例患者中有1例（1.6%）在术后30天内死亡。没有患者因三尖瓣反流或狭窄需要再次手术。术后7年的实际生存率为98.4%。58例存活患者中的58例（100%）进行了超声心动图检查。术后长达7年，67.2%的患者三尖瓣反流为微量，31%为轻度，1.8%为中度；随访期间未出现重度反流。我们的结果表明，自体心包三尖瓣环缩术对于中重度三尖瓣反流患者是一种有效的手术方法。该手术可提供持久、可重复的三尖瓣环缩术。
