Murashita Takashi, Okada Yukikatsu, Kanemitsu Hideo, Fukunaga Naoto, Konishi Yasunobu, Nakamura Ken, Koyama Tadaaki
Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
Ann Thorac Cardiovasc Surg. 2014;20(6):1026-33. doi: 10.5761/atcs.oa.13-00292. Epub 2014 Feb 28.
We investigated the long-term outcomes of suture/ring tricuspid valve annuloplasty for functional tricuspid regurgitation associated with degenerative mitral regurgitation.
We retrospectively reviewed patients who underwent flexible ring tricuspid valve annuloplasty (n = 120) or suture tricuspid valve annuloplasty (n = 42) for functional tricuspid regurgitation concomitant with surgery for degenerative mitral regurgitation (mean follow-up duration, 5.3 ± 5.1 years).
The mean age of patients was 62.5 ± 13.1 years. Thirty-day mortality was zero in the suture group, and 0.8% in the ring group. Tricuspid regurgitation grade at discharge was lower in the ring group ( p = 0.002). No difference was observed between survival and freedom from major cardiac/cerebrovascular adverse events between the groups. However, freedom from ≥moderate tricuspid regurgitation was higher in the ring group (Log-rank p = 0.003). From univariate analysis, the risk factors for ≥moderate TR were suture annuloplasty and preoperative tricuspid regurgitation grade. No reoperation for recurrent tricuspid regurgitation occurred in either group because symptoms experienced by patients with recurrent tricuspid regurgitation were relatively insignificant.
Concomitant tricuspid annuloplasty using flexible bands offered improved durability than suture annuloplasty for preventing postoperative tricuspid regurgitation progression.
我们研究了缝合/环扎三尖瓣瓣环成形术治疗与退行性二尖瓣反流相关的功能性三尖瓣反流的长期疗效。
我们回顾性分析了因功能性三尖瓣反流同时接受退行性二尖瓣反流手术而接受柔性环三尖瓣瓣环成形术(n = 120)或缝合三尖瓣瓣环成形术(n = 42)的患者(平均随访时间为5.3±5.1年)。
患者的平均年龄为62.5±13.1岁。缝合组30天死亡率为零,环扎组为0.8%。出院时环扎组三尖瓣反流分级较低(p = 0.002)。两组在生存率和无重大心脏/脑血管不良事件方面无差异。然而,环扎组无≥中度三尖瓣反流的比例更高(对数秩检验p = 0.003)。单因素分析显示,≥中度三尖瓣反流的危险因素为缝合瓣环成形术和术前三尖瓣反流分级。两组均未因复发性三尖瓣反流而再次手术,因为复发性三尖瓣反流患者的症状相对较轻。
对于预防术后三尖瓣反流进展,使用柔性带进行同期三尖瓣瓣环成形术比缝合瓣环成形术具有更好的耐久性。