Hayashi J, Saito A, Yamamoto K, Watanabe H, Ohzeki H, Eguchi S
Second Department of Surgery Niigata University, School of Medicine, Japan.
Thorac Cardiovasc Surg. 1996 Oct;44(5):230-3. doi: 10.1055/s-2007-1012025.
We reviewed clinical data on 29 patients (17 acquired disease and 12 congenital disease) who underwent tricuspid valve replacement using a Carpentier-Edwards porcine valve or a St. Jude Medical valve at Niigata University Hospital between January 1978 and October 1995, and analyzed risks related to the outcome. Age ranged from 8 to 62 years, and 17 females were included. New York Heart Association functional class was IV in 9 patients (31%). Previous valve surgery had been performed in 10 patients (34%). An urgent surgery was required in 4 patients and simultaneous mitral (with aortic) valve replacement in 13 (45%). Mean follow-up period was 6.7 years. Hospital mortality occurred in 5 patients (17.2%) and all of them had acquired valvular diseases with functional class IV. There were 6 late deaths and none of them related to the tricuspid prosthesis. Nonfatal morbidity occurred in 2 patients (a thrombosed valve and a chronic hemolytic anemia) with a St. Jude valve. Late functional class was I or II in all patients except 3 with severe left-ventricular dysfunction or bioprosthetic failure. Late postoperative echocardiographic examination showed moderate tricuspid stenosis or regurgitation in 3 patients with a Carpentier-Edwards valve. By the Kaplan-Meier method, functional class (P < 0.01) and baseline diseases (p < 0.05) were found to affect probability of freedom from cardiac- and/or valve-related mortality including hospital death. In conclusion, the present study indicates that similarly good outcome would be expected whether using a St. Jude Medical valve or a Carpentier-Edwards porcine valve, and that both functional class IV and combined acquired valvular disease are risk factors for mortality after tricuspid valve replacement. Patient-specific selection of the prosthesis would be preferable in tricuspid valve replacement.
我们回顾了1978年1月至1995年10月期间在新潟大学医院接受使用Carpentier-Edwards猪瓣膜或圣犹达医疗瓣膜进行三尖瓣置换术的29例患者（17例后天性疾病和12例先天性疾病）的临床资料，并分析了与预后相关的风险。年龄范围为8至62岁，其中包括17名女性。9例患者（31%）的纽约心脏协会心功能分级为IV级。10例患者（34%）曾接受过瓣膜手术。4例患者需要急诊手术，13例（45%）患者同时进行二尖瓣（伴主动脉瓣）置换术。平均随访期为6.7年。5例患者（17.2%）发生医院死亡，且均为心功能分级IV级的后天性瓣膜疾病患者。有6例晚期死亡，均与三尖瓣人工瓣膜无关。2例使用圣犹达瓣膜的患者发生非致命性并发症（1例瓣膜血栓形成和1例慢性溶血性贫血）。除3例严重左心室功能障碍或生物瓣膜功能衰竭的患者外，所有患者的晚期心功能分级均为I级或II级。术后晚期超声心动图检查显示，3例使用Carpentier-Edwards瓣膜的患者出现中度三尖瓣狭窄或反流。通过Kaplan-Meier方法发现，心功能分级（P < 0.01）和基线疾病（P < 0.05）会影响包括医院死亡在内的心脏和/或瓣膜相关死亡率的无事件概率。总之，本研究表明，使用圣犹达医疗瓣膜或Carpentier-Edwards猪瓣膜预计会有相似的良好预后，且心功能分级IV级和合并后天性瓣膜疾病均是三尖瓣置换术后死亡的危险因素。在三尖瓣置换术中，根据患者具体情况选择人工瓣膜更为可取。
