Abdelgawad Ahmed, Ramadan Mona, Arafat Heba, Abdel Aziz Ahmed
Cardiac Surgery Department, National Heart Institute, Egypt.
Anesthesia Department, National Heart Institute, Egypt.
Egypt Heart J. 2017 Dec;69(4):241-246. doi: 10.1016/j.ehj.2017.05.004. Epub 2017 Jun 7.
The purpose of this study was to compare the hospital outcome and short term results of tricuspid valve (TV) repair with three repair techniques for functional tricuspid regurgitation (TR), namely, flexible Dacron band, DeVega and segmental annuloplasty.
A total of 60 patients underwent TV repair at National Heart Institute from January 2013 to November 2014, of which 20 had DeVega procedure (DV), 20 had a segmental annuloplasty (SA) procedure and 20 had a Dacron band (DB) procedure. Concomitant procedures done for rheumatic left sided valve pathology consisted of mitral valve replacement in 70% of patients, and double valve replacement in 30% of patients. Clinical and echocardiographic follow-up data were obtained. Follow-up was 100% complete and was concluded after one year.
All demographic criteria and preoperative characteristics of the three studied groups were comparable except for preoperative right ventricular (RVEDD) size that was significantly bigger in Dacron band group as compared to the other two groups (3.18 ± 0.43 cm compared to 3.00 ± 0.33 cm (DV) and to 2.88 ± 0.35 cm (SA), p value of (0.045)). Similarly, all operative and postoperative criteria were comparable among the study groups. Noticeably, (RVEDD) size remodeled better postoperatively in (DB) group as compared to the other two groups, (2.54 ± 0.26 cm compared to 2.83 ± 0.311 cm (DV) and to 2.72 ± 0.29 cm (SA), mean difference values were group (0.64 ± 0.47 cm) for (DB) compared to (0.18 ± 0.29 cm) for (DV) or to (0.16 ± 0.45 cm) for (SA) with p value of 0.000. The majority of patients in each group did not have tricuspid regurgitation (TR) or mild degree (+1) of (TR) on discharge. After one year of follow-up, most of the patient had either no regurgitation or grade (+1 TR). Two patients (10%) in DV group and one patient (5%) in SA group had (+3 TR). There was no statistical significance in the incidence of hospital mortality, only one patient died in DB and one in DV group (5%) and no death happened after hospital mortality for the three groups after one year.
The three techniques are options to repair the tricuspid valve, however, placement of Dacron band in patients undergoing tricuspid valve repair is associated with better RV remodelling, and hence, a probable better right ventricular performance and better outcome of repair is expected. A higher number of patients are needed with longer follow up period to appreciate the effect on survival and rate of freedom from tricuspid regurgitation and re-intervention.
本研究的目的是比较采用三种修复技术治疗功能性三尖瓣反流（TR）时三尖瓣（TV）修复的医院结局和短期结果，这三种修复技术分别是使用柔性涤纶带、德维加修复法和节段性瓣环成形术。
2013年1月至2014年11月期间，共有60例患者在国家心脏研究所接受了三尖瓣修复术，其中20例行德维加手术（DV），20例行节段性瓣环成形术（SA），20例行涤纶带（DB）手术。因风湿性左心瓣膜病变而同期进行的手术包括70%的患者行二尖瓣置换术，30%的患者行双瓣膜置换术。获取了临床和超声心动图随访数据。随访完成率为100%，随访在一年后结束。
除术前右心室（RVEDD）大小外，三个研究组的所有人口统计学标准和术前特征均具有可比性，涤纶带组的术前右心室大小明显大于其他两组（3.18±0.43 cm，而DV组为3.00±0.33 cm，SA组为2.88±0.35 cm，p值为0.045）。同样，各研究组之间的所有手术和术后标准均具有可比性。值得注意的是，与其他两组相比，（DB）组术后（RVEDD）大小重塑更好（2.54±0.26 cm，而DV组为2.83±0.311 cm，SA组为2.72±0.29 cm，（DB）组的平均差值为（0.64±0.47 cm），而（DV）组为（0.18±0.29 cm），（SA）组为（0.16±0.45 cm），p值为0.000。每组中的大多数患者出院时没有三尖瓣反流（TR）或仅有轻度（+1）的（TR）。随访一年后，大多数患者无反流或为1级（+1 TR）。DV组有2例患者（10%）和SA组有1例患者（5%）出现（+3 TR）。医院死亡率发生率无统计学意义，DB组和DV组各有1例患者死亡（5%），三组在医院死亡后一年均无死亡病例。
这三种技术都是修复三尖瓣的选择，然而，在接受三尖瓣修复的患者中放置涤纶带与更好的右心室重塑相关，因此，预期右心室功能可能更好，修复效果更佳。需要更多患者并进行更长时间的随访，以评估对生存率、三尖瓣反流和再次干预自由度的影响。
