Department of Cardiac Surgery, University of Leipzig Heart Center, Leipzig, Germany.
J Thorac Cardiovasc Surg. 2012 May;143(5):1050-5. doi: 10.1016/j.jtcvs.2011.06.019. Epub 2011 Jul 27.
Surgical management of tricuspid valve regurgitation mainly consists of tricuspid valve annuloplasty, usually performed with implantation of a rigid ring or a flexible band.
We performed a retrospective analysis on 820 patients who underwent tricuspid valve repair between March 2002 and July 2009 with either a flexible Cosgrove-Edwards band (n = 415; Edwards Lifesciences LLC, Irvine, Calif) or a rigid Carpentier-Edwards Classic annuloplasty ring (n = 405; Edwards Lifesciences). Mean patient age was 69.2 ± 9.5 years, 54.1% were female, and average logistic EuroSCORE was 13.3% ± 12.5%. Concomitant procedures were performed in 94.6% of patients (mitral valve surgery, 80.6%; aortic valve surgery, 28.2%; coronary artery bypass grafting, 24.5%; atrial fibrillation ablation, 44.5%). One fifth of the operations were reoperative procedures. Follow-up was 94% complete, with mean duration of 21.0 ± 19.0 months.
Thirty-day mortality was 10.1% (Cosgrove-Edwards, 11.9%; Carpentier-Edwards, 8.4%), and 5-year survival was 62.4% (Carpentier-Edwards, 64.7%; Cosgrove-Edwards, 60.3%). Postoperative echocardiography showed significant improvement in tricuspid valve function, with reduction in tricuspid regurgitation grade from 2.3 ± 0.7 to 0.7 ± 0.7, and no differences between groups. Use of a Carpentier-Edwards ring, however, was associated with significantly higher risk of dehiscence (Carpentier-Edwards, 8.7%; Cosgrove-Edwards, 0.9%; P < .001), almost exclusively at the septal leaflet portion of the annulus. Multivariate analysis identified annuloplasty type as independently predicting ring dehiscence (odds ratio, 10.7; 95% confidence interval, 3.2-36.5; P < .001). Patients with annuloplasty dehiscence had more residual tricuspid regurgitation on predischarge echocardiography than did patients without dehiscence (1.4 ± 0.63 vs 0.7 ± 0.6; P < .001). Ten patients underwent reoperation for recurrent tricuspid regurgitation, 4 with ring dehiscence. Five-year freedom from reoperation was 95.3% (Cosgrove-Edwards, 97.7%; Carpentier-Edwards, 92.3%).
Although both rigid and flexible systems provide acceptable early tricuspid valve repair results, use of a rigid ring increases risk of subsequent ring dehiscence.
三尖瓣反流的手术治疗主要包括三尖瓣瓣环成形术，通常采用刚性环或柔性带进行植入。
我们对 2002 年 3 月至 2009 年 7 月期间接受三尖瓣修复的 820 例患者进行了回顾性分析，其中 415 例采用柔性 Cosgrove-Edwards 带（Edwards Lifesciences LLC，加利福尼亚州欧文），405 例采用刚性 Carpentier-Edwards Classic 瓣环成形环（Edwards Lifesciences）。患者平均年龄为 69.2±9.5 岁，54.1%为女性，平均 logistic EuroSCORE 为 13.3%±12.5%。94.6%的患者同时进行了其他手术（二尖瓣手术 80.6%；主动脉瓣手术 28.2%；冠状动脉旁路移植术 24.5%；心房颤动消融术 44.5%）。五分之一的手术为再次手术。随访率为 94%，平均随访时间为 21.0±19.0 个月。
术后 30 天死亡率为 10.1%（Cosgrove-Edwards，11.9%；Carpentier-Edwards，8.4%），5 年生存率为 62.4%（Carpentier-Edwards，64.7%；Cosgrove-Edwards，60.3%）。术后超声心动图显示三尖瓣功能明显改善，三尖瓣反流程度从 2.3±0.7 降至 0.7±0.7，两组间无差异。然而，使用 Carpentier-Edwards 环与瓣环裂开的风险显著增加相关（Carpentier-Edwards，8.7%；Cosgrove-Edwards，0.9%；P<.001），几乎仅发生在瓣环的隔瓣部分。多变量分析确定瓣环成形术类型是瓣环裂开的独立预测因素（优势比，10.7；95%置信区间，3.2-36.5；P<.001）。瓣环裂开的患者出院前超声心动图检查的残余三尖瓣反流程度高于未裂开的患者（1.4±0.63 与 0.7±0.6；P<.001）。10 例患者因复发性三尖瓣反流行再次手术，其中 4 例因瓣环裂开。5 年无再次手术生存率为 95.3%（Cosgrove-Edwards，97.7%；Carpentier-Edwards，92.3%）。
尽管刚性和柔性系统都能提供可接受的早期三尖瓣修复结果，但使用刚性环会增加随后瓣环裂开的风险。
