上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (7): 987-.doi: 10.3969/j.issn.1674-8115.2017.07.018

• 论著（临床研究） • 上一篇    下一篇

左心瓣膜术后继发性三尖瓣反流再次行三尖瓣置换术的临床分析

李伟，顾伟礼，张卫，方亮   

  1. 上海交通大学附属胸科医院心外科，上海  200030
  • 出版日期:2017-07-28 发布日期:2017-08-25
  • 通讯作者: 顾伟礼，电子信箱：gwl281@163.com
  • 作者简介:李伟（1975—），男，主治医师，硕士；电子信箱：fuo1126doc@163.com
  • 基金资助:
    上海市胸科医院科技发展基金项目（YZ14-01）

Clinical analysis on tricuspid valve replacement for secondary tricuspid regurgitation late after left-sided valve surgery#br#

LI Wei , GU Wei-li, ZHANG Wei, FANG Liang   

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai  200030, China
  • Online:2017-07-28 Published:2017-08-25
  • Supported by:
     Scientific and Technical Project of Shanghai Chest Hospital, YZ14-01

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摘要： 目的 · 分析左心瓣膜术后三尖瓣置换术的围术期及中期结果，探讨继发性三尖瓣反流发病机制以及手术危险因素。方法 · 回 顾性分析85 例左心瓣膜术后行三尖瓣置换术患者的围术期临床资料及中期随访结果。根据人工瓣膜种类分2 组，其中生物瓣组50 例，机械瓣组 35 例；根据手术径路分 2 组，其中右前外侧切口组 51 例，正中切口组 34 例。结果 · 住院死亡 7 例（8.2%），其中住院 早期死亡（术后 30 d 内）5 例（5.9%），住院晚期死亡（术后 30 d 后）2 例（2.4%），死亡原因均为术后严重右心功能衰竭及低心排血 量。生物瓣组死亡率（4/50）与机械瓣组（3/35）比较，差异无统计学意义（χ2=0.009，P=1.000）；正中切口组死亡率（6/34）与右前 外侧切口组（1/51）比较，差异有统计学意义（χ2=6.642，P=0.015）。随访 74 例（94.9%），随访时间（31.5±23.1）个月；中期死亡 4 例（5.4%），均为机械瓣组患者，其中心源性死亡 3 例，肠癌晚期死亡 1 例。随访的 70 例存活患者中，纽约心脏病学会（NYHA）心 功能分级Ⅰ～Ⅱ级，无发生抗凝意外及再次行三尖瓣置换手术者。结论 · 左心瓣膜术后继发性三尖瓣反流应密切随访，及时合理的三 尖瓣置换术可以取得良好的围术期及中期临床疗效；孤立性三尖瓣置换术首选右前外侧切口。

关键词: 左心瓣膜手术, 心脏瓣膜病, 三尖瓣置换术, 生物瓣, 机械瓣

Abstract:

 Objective · To analyse the outcomes of tricuspid valve replacement (TVR) for secondary tricuspid regurgitation (STR) late after left-sided valve surgery during perioperative period and mid-term follow-up, investigate mechanisms of STR and surgical risk factors.  Methods · A total of 85 consecutive patients who underwent the TVR surgery were analyzed. The perioperative and mid-term clinical outcomes were retrospectively investigated. The data were divided into bioprosthesis group (n=50) and mechanical prosthesis group (n=35) according to the prosthesis used, and divided into right anterolateral thoracotomy(RALT) group (n=51) and sternotomy(S) group (n=34) according to the surgical incision.  Results · In-hospital mortality was 8.2% (7/85). There was no significant difference in the mortality with different choice of bioprosthetic or mechanical valve (4/50 vs 3/35, χ2=0.009，P=1.000); while there was significant difference between S group and RALT group (6/34 vs 1/51，χ2=6.642, P=0.015). Seven cases all died of right heart failure and severe low cardiac output syndrome. Five (5.9%) cases died in perioperative within 30 in-hospital days and 2 (2.4%) cases died after 30 in-hospital days. Seventy-four cases were followed up. With the follow-up of (31.5±23.1) months, there were 4 case of late deaths(5.4%), all of whom were mechanical prosthesis, of whom 3 died in cardiac related death and 1 died in later period bowel cancer. Seventy cases survived in New York Heart Association （NYHA） class I-II with no coagulated accident and redo-TVR.  Conclusion · The perioperative and mid-term clinical outcomes are satisfied in timely and reasonable TVR with the standard follow-up for STR late after left-sided valve surgery. Right anterolateral incision is recommend for isolated TVR.

Key words:  left-sided valve surgery, valvular heart disease, tricuspid valve replacement, bioprosthetic valve, mechanical valve