Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France.
Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France.
J Thorac Cardiovasc Surg. 2017 Jul;154(1):214-223. doi: 10.1016/j.jtcvs.2016.12.062. Epub 2017 Feb 10.
Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated.
We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF.
We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014).
Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR (P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair (P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair.
In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR.
肺动脉瓣置换术（PVR）常应用于法洛四联症（TOF）修复术后的成人患者。对于存在三尖瓣反流（TR）的患者，PVR 时行三尖瓣（TV）修复术仍存在争议。
我们旨在评估在修复的 TOF 患者行 PVR 时行 TV 修复术的围手术期相关因素。
我们回顾性分析了 104 例行 PVR（2002-2014 年）的修复的 TOF（或其等效）患者。
初始完全矫正时和行 PVR 时的平均年龄分别为 20.1±17.2 个月和 26.3±9.5 岁。41 例患者术前存在明显的 TR：24 例为中度（组 M），17 例为重度（组 S）。共行 16 例 TV 修复术（每组 8 例）。初始完全修复后第 1 年观察到的中重度 TR 与 PVR 时重度 TR 显著相关（P＜0.001）。在组 M 患者中，无论是否行 TV 修复，TR 均得到改善，而在组 S 中，未行 TV 修复的 7 例患者仍存在明显的残余 TR。未观察到行 TV 同期修复术患者出现任何情况（P=0.002）。在这些仍存在明显残余 TR 的患者中，有 2 例需要行三尖瓣置换术。同时行 TV 修复可显著改善组 S 患者的纽约心脏协会（NYHA）心功能分级。
在修复的 TOF 成人患者中，PVR 时行 TV 修复术是安全的。如果在中期随访时，术前 TR 为中度时行 TV 修复术可能没有益处，那么在术前 TR 严重的情况下，TV 修复术可能会改善三尖瓣功能和患者的功能状态。
