Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Semin Thorac Cardiovasc Surg. 2022 Spring;34(1):205-212. doi: 10.1053/j.semtcvs.2021.03.034. Epub 2021 May 7.
Cone repair (CR) uses native tissue for tricuspid valve (TV) repair and provides potential for growth. Results after CR were investigated in different age groups including several surgical modifications. Single institution retrospective analysis of all CR excluding neonatal procedures. Endpoints included TV reoperation, late tricuspid regurgitation (TR) and death. Between April 2006 and August 2019, 157 patients underwent CR at a median age of 11.7 years (range, 0.3-57.2). 20% (n=32) of patients had previous surgery. Repair modifications included atrial reduction (n=111,71%), right ventricular plication (n=85,55%), leaflet augmentation (n=36,23%), papillary muscle repositioning (n=50,32%), ring annuloplasty (n=70,45%). Early re-operation for recurrent TR occurred in 11 patients. Median follow-up time was 4.3 years (range, 9d-12.3y). There was no significant association between age at repair and time to TV reoperation (p=0.25). However, age <4 years at CR was identified as the most discriminating binary age threshold for the patients with TV reoperation (25.0% in <4y group vs 9.3% in the ≥4y group). Placement of an annuloplasty ring was protective against ≥moderate TR (OR=0.39, 95% CI 0.16-0.95, p=0.039). Freedom from late TV re-operation was 94.1% at 7 years. Survival was 97.9% at 6 years. Repair after age 18 years was associated with mortality in early follow-up (p=0.037). Mid-term results for CR are favorable in children and adults. Time to TV reoperation may be shorter when CR is performed before age four years, but this result requires confirmation in a larger sample. An annuloplasty ring should be considered when appropriate.
圆锥修复术（CR）使用自身组织修复三尖瓣（TV），并为其生长提供了潜力。研究人员在不同年龄组中调查了 CR 的结果，其中包括几种手术改良。对所有排除新生儿手术的 CR 进行单中心回顾性分析。终点包括 TV 再次手术、晚期三尖瓣反流（TR）和死亡。2006 年 4 月至 2019 年 8 月，157 例患者在中位年龄 11.7 岁（范围，0.3-57.2 岁）接受了 CR。20%（n=32）的患者之前接受过手术。修复改良包括心房缩小术（n=111，71%）、右心室折叠术（n=85，55%）、瓣叶增强术（n=36，23%）、乳头肌重新定位术（n=50，32%）、环形瓣环成形术（n=70，45%）。11 例患者因复发性 TR 早期再次手术。中位随访时间为 4.3 年（范围，9d-12.3y）。修复时年龄与 TV 再次手术时间之间无显著相关性（p=0.25）。然而，CR 时年龄<4 岁被确定为 TV 再次手术患者最具鉴别力的二元年龄阈值（<4y 组 25.0%，≥4y 组 9.3%）。瓣环成形术环的放置可预防≥中度 TR（OR=0.39，95%CI 0.16-0.95，p=0.039）。7 年时晚期 TV 再手术无失败率为 94.1%。6 年时生存率为 97.9%。18 岁以后的修复与早期随访中的死亡率相关（p=0.037）。CR 的中期结果在儿童和成人中均良好。当 CR 在 4 岁之前进行时，TV 再次手术的时间可能较短，但这一结果需要在更大的样本中得到证实。在适当情况下，应考虑使用瓣环成形术环。
