Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
Department of Cardiovascular Surgery, German Heart Centre Munich at the Technical University Munich, Munich, Germany.
J Thorac Cardiovasc Surg. 2020 Dec;160(6):1545-1553. doi: 10.1016/j.jtcvs.2020.05.032. Epub 2020 May 29.
We aimed to investigate tricuspid valve function and adverse events after conventional repair and valve replacement for Ebstein's anomaly and compare them with cone repair.
The medical records of 151 patients (mean age, 25 years; 62% were female) who underwent operation in a single center from 1985 to 2018 were retrospectively analyzed. To determine tricuspid valve regurgitation during follow-up, serial echocardiographic examination was used (n = 2397, tricuspid regurgitation grades were graphed for every patient).
Thirty-nine patients underwent cone repair, 107 patients underwent other repair techniques, and 5 patients underwent valve replacement. The operative mortality was 1.3% (n = 2). Failed valve repair (defined as in-hospital death, conversion to replacement, or in-hospital reoperation) was less frequent after cone repair than after other repair techniques (5%, n = 2 vs 20%, n = 21, P = .039). Mean follow-up was 12.3 years (cone repair: 3.7 years). The 5-year cumulative incidence of moderate or greater recurrent tricuspid regurgitation was lower after cone repair than after other repair techniques (8% vs 32%, P = .03). Among the patients undergoing other repair techniques, the 15-year cumulative incidence of moderate or greater recurrent tricuspid regurgitation, severe tricuspid regurgitation, and reoperation was 58%, 37%, and 31%, respectively. During follow-up, 18 patients died (13 of cardiac and 5 of noncardiac causes). Among patients who died of cardiac causes, 10 of 13 had all 3 characteristics-moderate or greater tricuspid regurgitation, atrial fibrillation, and New York Heart Association classification III and IV-at their last medical evaluation.
Before cone repair, recurrent tricuspid regurgitation was considerable. Cone repair provided a higher rate of successful repair and a lower incidence of moderate or greater recurrent tricuspid regurgitation at the midterm follow-up.
我们旨在研究三尖瓣功能，并比较传统修复术和瓣膜置换术治疗Ebstein 畸形的不良事件，同时将其与圆锥修补术进行比较。
回顾性分析 1985 年至 2018 年期间在单中心接受手术的 151 例患者（平均年龄 25 岁，62%为女性）的病历资料。为了在随访期间确定三尖瓣反流情况，我们使用了连续的超声心动图检查（n=2397，为每位患者绘制三尖瓣反流等级图）。
39 例患者接受了圆锥修补术，107 例患者接受了其他修复技术，5 例患者接受了瓣膜置换术。手术死亡率为 1.3%（n=2）。与其他修复技术相比，圆锥修补术后失败的瓣膜修复（定义为院内死亡、转为置换或院内再次手术）发生率较低（5%，n=2 与 20%，n=21，P=0.039）。平均随访时间为 12.3 年（圆锥修补术：3.7 年）。圆锥修补术后 5 年中度或以上复发性三尖瓣反流的累积发生率低于其他修复技术（8%与 32%，P=0.03）。在接受其他修复技术的患者中，15 年中度或以上复发性三尖瓣反流、重度三尖瓣反流和再次手术的累积发生率分别为 58%、37%和 31%。随访期间，18 例患者死亡（13 例为心脏原因，5 例为非心脏原因）。在死于心脏原因的患者中，13 例中有 10 例在最后一次医学评估时均有中度或以上三尖瓣反流、心房颤动和纽约心脏协会（NYHA）心功能分级 III 或 IV 这 3 种特征。
在圆锥修补术之前，复发性三尖瓣反流相当常见。圆锥修补术在中期随访中提供了更高的成功修复率和更低的中度或以上复发性三尖瓣反流发生率。
