Hasde Ali İhsan, Özçınar Evren, Çakıcı Mehmet, Baran Çağdaş, İnan Mustafa Bahadır, Yazıcıoğlu Levent, Eryılmaz Sadık, Akar Ahmet Rüçhan
Department of Cardiovascular Surgery, Medicine Faculty of Ankara University, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Sep 16;26(4):519-527. doi: 10.5606/tgkdc.dergisi.2018.16229. eCollection 2018 Oct.
The aim of this study was to evaluate the clinical outcomes of tricuspid valve repair using aortic cross-clamping versus using beating heart surgery.
A total of 208 patients (67 males, 141 females; mean age 61.5±9.2 years; range, 29 to 81 years) who underwent concomitant cardiac surgery and tricuspid valve repair between January 2007 and January 2016 at a single center were included. Two surgical strategies for tricuspid valve repair with aortic cross-clamping (n=102) or on beating heart (n=106) were compared. Primary endpoints were in-hospital mortality and the rate of permanent pacemaker placement after surgery. Secondary endpoints were cross-clamp and cardiopulmonary bypass times, postoperative inotropic support, temporary pacemaker requirement, and residual tricuspid regurgitation at discharge and at one year.
Overall hospital mortality was 7% (n=14) (cross-clamping 7% vs. beating heart 7%; p>0.05). The mean cross-clamp and cardiopulmonary bypass times were significantly longer in the aortic cross-clamping group (p=0.0001). Also, a higher number of patients in this group needed inotropic support (78/102) than the beating heart group (57/106) (p<0.05). The rate of postoperative left bundle branch block was higher in the cross-clamping group (14% vs. 5%, respectively; p<0.05). The rate of permanent pacemaker placement was also significantly higher in the cross-clamping group than the beating heart group (11.8% vs. 2.8%, respectively; p<0.05). At discharge, residual >2 tricuspid regurgitation was more commonly seen in the cross-clamping group (16% vs. 3%, respectively; p=0.0023). At one year of follow-up, residual >2 tricuspid regurgitation was present in 22 patients (23%) in the aortic crossclamping group and in eight patients (8%) in the beating heart group (p=0.0048).
Tricuspid valve repair on beating heart offers less inotropic support and a lower rate of postoperative permanent pacemaker placement requirement and residual tricuspid regurgitation, although both techniques yield similar postoperative clinical outcomes. These results support the use of tricuspid valve repair on a beating heart in concomitant left-sided valvular heart surgery.
本研究的目的是评估采用主动脉阻断与心脏不停跳手术进行三尖瓣修复的临床效果。
纳入2007年1月至2016年1月在单中心接受同期心脏手术和三尖瓣修复的208例患者（男性67例，女性141例；平均年龄61.5±9.2岁；范围29至81岁）。比较了两种三尖瓣修复手术策略，即主动脉阻断（n = 102）和心脏不停跳（n = 106）。主要终点是住院死亡率和术后永久起搏器植入率。次要终点是主动脉阻断和体外循环时间、术后血管活性药物支持、临时起搏器需求以及出院时和术后一年的三尖瓣残余反流情况。
总体住院死亡率为7%（n = 14）（主动脉阻断组7% vs. 心脏不停跳组7%；p>0.05）。主动脉阻断组的平均主动脉阻断和体外循环时间明显更长（p = 0.0001）。此外，该组需要血管活性药物支持的患者数量（78/102）高于心脏不停跳组（57/106）（p<0.05）。主动脉阻断组术后左束支传导阻滞发生率更高（分别为14% vs. 5%；p<0.05）。永久起搏器植入率在主动脉阻断组也明显高于心脏不停跳组（分别为11.8% vs. 2.8%；p<0.05）。出院时，主动脉阻断组三尖瓣残余反流>2级更为常见（分别为16% vs. 3%；p = 0.0023）。在随访一年时，主动脉阻断组有22例患者（23%）存在三尖瓣残余反流>2级，心脏不停跳组有8例患者（8%）存在（p = 0.0048）。
心脏不停跳三尖瓣修复术所需的血管活性药物支持较少，术后永久起搏器植入需求率和三尖瓣残余反流率较低，尽管两种技术的术后临床效果相似。这些结果支持在同期左侧瓣膜性心脏病手术中采用心脏不停跳三尖瓣修复术。
