Department of Cardiac Surgery, San Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy.
Eur J Cardiothorac Surg. 2010 Jun;37(6):1297-303. doi: 10.1016/j.ejcts.2009.12.020. Epub 2010 Feb 1.
This study assesses the results of the 'clover technique' (suturing together the middle point of the free edges of the tricuspid leaflets) for the treatment of tricuspid regurgitation (TR) due to severe prolapse or tethering.
From 2001, 66 patients with severe TR due to prolapsing or tethered leaflets underwent 'clover repair'. Annuloplasty was associated in 64 patients (97%). The aetiology of TR was degenerative in 52 cases (79%), post-traumatic in eight (12%) and secondary to dilated cardiomyopathy (DCM) in six (9%). The main mechanism of TR was prolapse/flail of one leaflet in 15 patients (23%), of two leaflets in 31 (47%) and of all three leaflets in 14 (21%). The remaining six patients (9%) presented with severe leaflets' tethering.
Four deaths (6%) occurred during hospitalisation and one patient died 3.6 years after surgery. Survival was 91 + or - 4.1% at 5 years. Follow-up of the 62 hospital survivors was 100% complete (mean length 3.5 + or - 1.6 years, range 13 months-7.1 years). At the last echocardiogram, no or mild TR was detected in 55 (88.7%) patients, moderate (2+/4+) in six (9.6%) and severe (4+/4+) in one patient (1.6%). Mean tricuspid valve area and gradient were 4.3 + or - 0.6 cm(2) and 2.8 + or -1.4 mmHg. In six patients, stress echocardiography was performed and no signs of tricuspid stenosis were detected. At the multivariable analysis, the degree of TR at hospital discharge was identified as the only predictor of TR > or = 2+ at follow-up.
Midterm clinical and echocardiographic results confirm the role of the 'clover technique' in the surgical treatment of TR due to lesions, which are unlikely to be effectively treatable by annuloplasty alone.
本研究评估了“三叶草技术”（缝合三尖瓣游离缘中点）治疗因严重脱垂或牵拉导致的三尖瓣反流（TR）的效果。
自 2001 年以来，66 例因瓣叶脱垂或牵拉导致严重 TR 的患者接受了“三叶草修复”。64 例（97%）患者同时行瓣环成形术。TR 的病因在 52 例（79%）中为退行性病变，8 例（12%）为创伤性，6 例（9%）继发于扩张型心肌病（DCM）。TR 的主要机制为 15 例（23%）单叶瓣脱垂/连枷样运动，31 例（47%）双叶瓣脱垂，14 例（21%）三叶瓣均脱垂。其余 6 例（9%）患者表现为严重瓣叶牵拉。
住院期间死亡 4 例（6%），术后 1 例患者死亡。5 年生存率为 91±4.1%。62 例住院幸存者的随访率为 100%（平均随访时间 3.5±1.6 年，范围 13 个月至 7.1 年）。最后一次超声心动图检查，55 例（88.7%）患者无或轻度 TR，6 例（9.6%）中度（2+/4+），1 例（1.6%）重度（4+/4+）。平均三尖瓣瓣口面积和跨瓣压差分别为 4.3±0.6cm²和 2.8±1.4mmHg。6 例患者行运动超声心动图检查，均未发现三尖瓣狭窄征象。多变量分析显示，出院时 TR 程度是预测随访时 TR≥2+的唯一因素。
中期临床和超声心动图结果证实了“三叶草技术”在治疗因病变导致的 TR 中的作用，这些病变单凭瓣环成形术可能难以有效治疗。
