Fang Zhi, Meng Wei, Zhang Eryong
Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu Sichuan 610041, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2013 Oct;27(10):1230-3.
To compare and evaluate the short-term outcomes of 3 different tricuspid valve plasty for functional tricuspid regurgitation (TR) in patients with rheumatic heart disease.
Between October 2010 and June 2011, 148 patients with rheumatic heart disease undergoing left heart valve replacement and tricuspid valve plasty for functional TR were enrolled in the study. There were 32 males and 116 females with an average age of 47.5 years (range, 15-66 years). The patients were divided into 3 groups depending on tricuspid valve plasty: Cosgrove-Edwards annuloplasty ring group (annuloplasty ring group, 58 cases), Kay annuloplasty group (Kay group, 61 cases), and DeVega annuloplasty group (DeVaga group, 29 cases). There was no significant difference in general data among groups (P > 0.05), except more severe TR degree, higher atrial fibrillation, and higher radiofrequency ablation in annuloplasty ring group (P < 0.05). Perioperative data were recorded. The heart function was evaluated according to the standard of New York Heart Association (NYHA). Echocardiography (ECG) was used to record the TR class during perioperative period and follow-up.
After operation, 1 case in Kay group and 1 case in annuloplasty ring group were dead because of low cardiac output syndrome. Pneumonia happened in 2 cases of Kay group and in 1 case of annuloplasty ring group; re-operation was performed in 1 case of annuloplasty ring group because of sternal dehiscence. There was no significant difference in perioperative complication among 3 groups (P = 0.840). The TR degree was significantly improved at discharge when compared with preoperative degree in 3 groups (P < 0.001). A total of 146 patients were followed up 6-12 months (mean, 7.3 months). The NYHA grade of 3 groups at last follow-up was improved when compared with preoperative grade (P < 0.001), but no significant difference among 3 groups (chi2 = 0.120, P = 0.942). The TR degree at last follow-up was all improved in 3 groups when compared with preoperative degree (P < 0.001); the improved efficiency showed significant difference among 3 groups (chi2 = 26.827, P = 0.000), it was significantly better in annuloplasty ring group than in the other 2 groups (P < 0.001), but no significant difference between DeVega group and Kay group (Z = 1.467, P = 0.142).
The early improved efficiency of TR after Cosgrove-Edwards annuloplasty is superior to that of Kay annuloplasty and DeVega annuloplasty.
比较和评估3种不同的三尖瓣成形术治疗风湿性心脏病功能性三尖瓣反流（TR）的短期疗效。
2010年10月至2011年6月，148例接受左心瓣膜置换及功能性TR三尖瓣成形术的风湿性心脏病患者纳入本研究。其中男性32例，女性116例，平均年龄47.5岁（范围15 - 66岁）。根据三尖瓣成形术方式将患者分为3组：Cosgrove-Edwards瓣环成形环组（瓣环成形环组，58例）、Kay瓣环成形术组（Kay组，61例）、DeVega瓣环成形术组（DeVaga组，29例）。除瓣环成形环组TR程度更严重、心房颤动发生率更高及射频消融率更高外（P < 0.05），各组一般资料差异无统计学意义（P > 0.05）。记录围手术期数据。根据纽约心脏协会（NYHA）标准评估心功能。采用超声心动图（ECG）记录围手术期及随访期间的TR分级。
术后，Kay组1例和瓣环成形环组1例因低心排血量综合征死亡。Kay组2例、瓣环成形环组1例发生肺炎；瓣环成形环组1例因胸骨裂开行再次手术。3组围手术期并发症差异无统计学意义（P = 0.840）。3组出院时TR程度与术前相比均显著改善（P < 0.001）。共146例患者获随访6 - 12个月（平均7.3个月）。3组末次随访时NYHA分级与术前相比均改善（P < 0.001），但3组间差异无统计学意义（χ2 = 0.120，P = 0.942）。3组末次随访时TR程度与术前相比均改善（P < 0.001）；改善效率3组间差异有统计学意义（χ2 = 26.827，P = 0.000），瓣环成形环组显著优于其他2组（P < 0.001），但DeVega组与Kay组差异无统计学意义（Z = 1.467，P = 0.142）。
Cosgrove-Edwards瓣环成形术后TR的早期改善效率优于Kay瓣环成形术和DeVega瓣环成形术。
