Ariyoshi Tsuneo, Hashizume Kouji, Taniguchi Shinichirou, Miura Takashi, Matsukuma Seiji, Nakaji Shun, Eishi Kiyoyuki
The Department of Cardiovascular Surgery, Nagasaki University School of Medicine, Nagasaki, Japan.
Ann Thorac Cardiovasc Surg. 2013;19(6):428-34. doi: 10.5761/atcs.oa.12.01929. Epub 2013 Jan 31.
The purpose of this study was to examine changes in severity of secondary tricuspid regurgitation (TR) accompanying mitral valve disease, and to identify factors predicting failure of improvement in TR after mitral valve surgery.
We studied 99 patients who had TR of grade ≥2+ preoperatively, 47 with tricuspid annuloplasty (TAP Group) performed concurrently, and 52 with mitral surgery alone (nTAP Group). Predictors of failure of improvement in TR in the nTAP Group were analyzed.
The mean follow-up period was 4.6 ± 2.7 years. There was a significant difference between the TAP and nTAP Groups in TR improvement (93.6% vs. 67.3% respectively, p <0.001) and in change of TR grade (-2.1 ± 1.0 vs. -0.9 ± 1.0 respectively, p <0.001). Univariate analysis in the nTAP Group identified rheumatic etiology, atrial fibrillation, mitral stenosis (MS), and large left atrium prior to surgery as risk factors for failure of improvement. In multivariate analysis atrial fibrillation was identified as a predictor of failure of improvement (p = 0.004).
Our results suggest that TAP should be performed concurrently with mitral valve surgery in patients with secondary TR of grade ≥2+, especially those having atrial fibrillation, even if TR is not severe.
本研究旨在探讨二尖瓣疾病伴发的继发性三尖瓣反流（TR）严重程度的变化，并确定预测二尖瓣手术后TR改善失败的因素。
我们研究了99例术前TR分级≥2+的患者，其中47例同时进行了三尖瓣环成形术（TAP组），52例仅进行了二尖瓣手术（非TAP组）。分析了非TAP组中TR改善失败的预测因素。
平均随访期为4.6±2.7年。TAP组和非TAP组在TR改善方面（分别为93.6%和67.3%，p<0.001）以及TR分级变化方面（分别为-2.1±1.0和-0.9±1.0，p<0.001）存在显著差异。非TAP组的单因素分析确定风湿病因、心房颤动、二尖瓣狭窄（MS）和术前左心房增大为改善失败的危险因素。多因素分析确定心房颤动为改善失败的预测因素（p=0.004）。
我们的结果表明，对于TR分级≥2+的继发性TR患者，尤其是那些患有心房颤动的患者，即使TR不严重，也应在二尖瓣手术的同时进行TAP。
