Kim Gwan Sic, Kim Jae-Joong, Kim Joon Bum, Kim Dae-Hee, Song Jong-Min, Yun Tae-Jin, Choo Suk Jung, Kang Duk-Hyun, Chung Cheol Hyun, Song Jae-Kwan, Lee Jae Won, Jung Sung-Ho
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine.
Circ J. 2014;78(7):1654-60. doi: 10.1253/circj.cj-13-1065. Epub 2014 Apr 25.
Long-term echocardiographic data on quantitative assessment of tricuspid and mitral regurgitation after heart transplantation are scarce.
From November 1992 to December 2008, the medical records for 201 patients (mean age, 42.8±12.4 years, 47 females) who underwent heart transplantation were reviewed. Quantitative assessment of mitral and tricuspid valve function was performed using transthoracic echocardiography through long-term follow-up. A total of 196 (97.5%) patients were evaluated with echocardiography for more than 6 months postoperatively. During a mean echocardiography follow-up duration of 89.9±54.3 months, 23 (11.4%) patients showed either tricuspid regurgitation (TR >mild; n=21, 10.4%) or mitral regurgitation (MR >mild; n=6, 3.0%); 4 (2.0%) patients experienced both significant TR and MR. Freedom from moderate-to-severe TR at 10 years was 85.5±5.1% and 93.4±2.2% for the standard and bicaval techniques, respectively (P=0.531). Freedom from moderate-to-severe MR at 10 years was 96.0±2.7% and 98.6±1.0%, respectively, for the 2 techniques (P=0.252). In multivariate analysis, older-age donor emerged as the only independent predictor of significant TR (hazard ratio 1.06, 95% confidence interval 1.01-1.12, P=0.012).
The long-term results of atrioventricular function after heart transplantation in adults were excellent regardless of anastomotic technique. Older-age donor was significantly associated with the development of postoperative TR.
关于心脏移植术后三尖瓣和二尖瓣反流定量评估的长期超声心动图数据稀缺。
回顾了1992年11月至2008年12月期间201例行心脏移植患者（平均年龄42.8±12.4岁，女性47例）的病历。通过长期随访，采用经胸超声心动图对二尖瓣和三尖瓣功能进行定量评估。共有196例（97.5%）患者在术后6个月以上接受了超声心动图评估。在平均89.9±54.3个月的超声心动图随访期间，23例（11.4%）患者出现三尖瓣反流（TR>轻度；n=21，10.4%）或二尖瓣反流（MR>轻度；n=6，3.0%）；4例（2.0%）患者同时出现显著的TR和MR。标准技术和双腔静脉技术10年时无中度至重度TR的发生率分别为85.5±5.1%和93.4±2.2%（P=0.531）。两种技术10年时无中度至重度MR的发生率分别为96.0±2.7%和98.6±1.0%（P=0.252）。多因素分析显示，供体年龄较大是显著TR的唯一独立预测因素（风险比1.06，95%置信区间1.01-1.12，P=0.012）。
无论吻合技术如何，成人心脏移植术后房室功能的长期结果均良好。供体年龄较大与术后TR的发生显著相关。
