Department of Adult Cardiac Surgery, Prince Sultan Cardiac Center, Riyadh, Kingdom of Saudi Arabia.
J Thorac Cardiovasc Surg. 2011 Aug;142(2):308-13. doi: 10.1016/j.jtcvs.2010.04.047. Epub 2010 Dec 15.
Functional tricuspid regurgitation (FTR) worsens over time, and its natural history is unfavorable. An aggressive surgical strategy, using the echocardiographic systolic dimensions of the tricuspid annulus (sysTA), can be helpful to reduce the detrimental late effects of FTR.
From March 2006 to February 2008, 298 patients, with at least FTR grade 1+, underwent mitral valve surgery. Of these 298 patients, 167 underwent tricuspid repair (treated group [T], moderate-or-greater FTR in 108 and mild in 59, with sysTA > 24 mm) and 137 did not (untreated group [UT], moderate-or-greater FTR in 16 and mild in 115; 81 with sysTA > 24 mm and 34 with sysTA of ≤ 24 mm). The 256 survivors underwent echocardiographic examination at a mean follow-up of 13 ± 8 months.
Preoperatively, at discharge, and at the follow-up examination, the mean FTR grade was 1.11 ± 0.32, 0.87 ± 0.49, and 1.03 ± 0.57 (P = NS) in the UT group and 2.11 ± 0.92, 0.45 ± 0.36, and 0.48 ± 0.32 (P < .001) in the T group. A total of 24 patients had FTR grade 2 or greater, 16 (14.5%) in the UT group and 8 (5.5%) in the T group (P = .026). In the UT group, 10 of 16 patients had sysTA of 25 to 28 mm and 6 of 10 had sysTA greater than 28 mm. No patient with mild FTR and sysTA of 24 mm or less had an increased FTR grade. Globally, 12 patients (10.9%) had an increased FTR grade in the UT group versus none in the T group (P < .001). Patients with postoperative atrial fibrillation had less residual FTR if annuloplasty had been performed (1.6 ± 0.7 vs 0.91 ± 0.63, P = .005).
An aggressive strategy for FTR correction, using the sysTA, was able to reduce the FTR grade 1 year after surgery, but mitral surgery alone could not.
功能性三尖瓣反流（FTR）随时间恶化，其自然史不佳。使用三尖瓣环的超声心动图收缩尺寸（sysTA）的积极手术策略可以帮助减少 FTR 的晚期不良影响。
从 2006 年 3 月到 2008 年 2 月，298 例至少 FTR 分级为 1+的患者接受了二尖瓣手术。在这 298 例患者中，167 例行三尖瓣修复术（治疗组[T]，108 例中中度或重度 FTR，59 例轻度 FTR，sysTA>24mm），137 例行未修复术（未治疗组[UT]，16 例中度或重度 FTR，115 例轻度 FTR；81 例 sysTA>24mm，34 例 sysTA≤24mm）。256 例存活患者在平均 13±8 个月的随访时接受了超声心动图检查。
在 UT 组中，术前、出院时和随访检查时，平均 FTR 分级分别为 1.11±0.32、0.87±0.49 和 1.03±0.57（P=NS），在 T 组中分别为 2.11±0.92、0.45±0.36 和 0.48±0.32（P<0.001）。共有 24 例患者 FTR 分级为 2 级或更高，UT 组 16 例（14.5%），T 组 8 例（5.5%）（P=0.026）。在 UT 组中，16 例中有 10 例 sysTA 为 25 至 28mm，其中 10 例中有 6 例 sysTA 大于 28mm。没有轻度 FTR 和 sysTA 为 24mm 或更低的患者出现 FTR 分级增加。总体而言，UT 组中有 12 例（10.9%）患者 FTR 分级增加，而 T 组中无患者（P<0.001）。如果行瓣环成形术，术后心房颤动患者的残余 FTR 较少（1.6±0.7 vs 0.91±0.63，P=0.005）。
使用 sysTA 积极纠正 FTR 策略可降低术后 1 年 FTR 分级，但单纯二尖瓣手术不能。
