Teng Peng, Dai Xiaoyi, Zou Yu, Yuan Shuai, Chen Yan, Ma Liang, Ni Yiming
Department of Cardiovascular Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
College of Medicine, Zhejiang University, Hangzhou, China.
Front Cardiovasc Med. 2022 Apr 26;9:889163. doi: 10.3389/fcvm.2022.889163. eCollection 2022.
This study aimed to investigate the course of tricuspid annulus dilation in functional tricuspid regurgitation with varied severities by direct intraoperative assessment.
A total of 317 patients who underwent left heart surgery and concomitant tricuspid repair were divided into three groups according to the severity of the functional tricuspid regurgitation (mild, moderate and severe). Demographic and echocardiographic data were collected. The length of each tricuspid annulus segment was measured intraoperatively. The risk factors for preoperative severe functional tricuspid regurgitation and its postoperative recurrence were identified, and the impact of each tricuspid annulus segment on postoperative recurrence was compared.
In the course of tricuspid annulus dilation, the posterior annulus dilated 17% (group 1: 33.31 ± 6.94 mm vs. group 2: 35.56 ± 7.63 vs. group 3: 38.98 ± 8.70, < 0.01), the anterior annulus dilated 13.4% (group 1: 36.71 ± 6.30 mm vs. group 2: 38.21 ± 8.35 vs. group 3: 41.63 ± 9.20, < 0.01), and the septal annulus dilated 11.4% (group 1: 38.11 ± 5.28 mm vs. group 2: 39.76 ± 6.90 vs. group 3: 42.46 ± 7.50, < 0.01). Tricuspid annulus circumference index ( < 0.01) independently correlated with preoperative severe tricuspid regurgitation and postoperative recurrence. When patients were grouped based on the length of each segment, the septal annulus demonstrated significantly higher sensitivity ( < 0.001) to postoperative recurrence than the anterior ( = 0.085) or posterior annulus ( = 0.262).
This study revealed that each segment of tricuspid annulus could dilate in functional tricuspid regurgitation and highlighted the potential benefits of septal annulus plication in tricuspid annuloplasty, which may aid in the development of a methodology for prosthetic ring annuloplasty.
本研究旨在通过术中直接评估，探讨不同严重程度的功能性三尖瓣反流中三尖瓣环扩张的过程。
总共317例行左心手术并同期进行三尖瓣修复的患者，根据功能性三尖瓣反流的严重程度（轻度、中度和重度）分为三组。收集人口统计学和超声心动图数据。术中测量三尖瓣环各段的长度。确定术前严重功能性三尖瓣反流及其术后复发的危险因素，并比较三尖瓣环各段对术后复发的影响。
在三尖瓣环扩张过程中，后瓣环扩张17%（第1组：33.31±6.94mm vs.第2组：35.56±7.63 vs.第3组：38.98±8.70，<0.01），前瓣环扩张13.4%（第1组：36.71±6.30mm vs.第2组：38.21±8.35 vs.第3组：41.63±9.20，<0.01），间隔瓣环扩张11.4%（第1组：38.11±5.28mm vs.第2组：39.76±6.90 vs.第3组：42.46±7.50，<0.01）。三尖瓣环周长指数（<0.01）与术前严重三尖瓣反流和术后复发独立相关。当根据各段长度对患者进行分组时，间隔瓣环比前瓣环（=0.085）或后瓣环（=0.262）对术后复发表现出显著更高的敏感性（<0.001）。
本研究表明，在功能性三尖瓣反流中三尖瓣环的各段均可扩张，并强调了间隔瓣环折叠在三尖瓣环成形术中的潜在益处，这可能有助于开发人工瓣环成形术的方法。
