Tricuspid valve repair:: An old disease, a modern experience
Tricuspid valve repair:: An old disease, a modern experience
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DOI：
10.1016/j.athoracsur.2004.06.067
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发表时间：
2004-12-01
影响因子：
4.6
通讯作者：
Revuelta, JM
中科院分区：
文献类型：
--
作者：
Bernal, JM;Gutiérrez-Morlote, J;Revuelta, JM
背景我们回顾了1987年至1999年间因二尖瓣或主动脉瓣或两者同时存在而需要手术矫正的三尖瓣疾病患者的经验。我们研究了232例连续患者（平均年龄59.8岁），平均随访6.8年（范围2 - 12年）。所有患者均进行了多普勒超声心动图检查，其中135例进行了血流动力学检查。中位三尖瓣关闭不全为3+。病因为风湿性心脏病186例，退行性心脏病46例。所有患者在二尖瓣或主动脉瓣手术时均接受了缝线瓣环成形术（De Vega或节段性）。三尖瓣病变的功能。结果：住院病死率为8.1%，晚期病死率为23.3%。这些数字与所进行的瓣环成形术类型无关。医院死亡率的预测因素是生物假体、肾功能不全、心肺转流时间和强心剂的使用。晚期死亡率的预测因素为年龄大于60岁，左心室射血分数小于0.50，纽约心脏协会心功能分级IV级。12年时，精算生存率为50.5% +/-6.1%，无再次手术率为75.7% +/-7.3%。11年时无瓣膜相关并发症的精算曲线为39.0% +/- 6.3%。尽管在心脏瓣膜病的诊断和治疗中使用了现代技术进步，但三尖瓣关闭不全仍然是二尖瓣或主动脉瓣或两者并存疾病患者的不良预后因素。(C)2004年由胸外科医师协会发布。
Background. We review our experience in patients who required surgical correction of tricuspid valve disease with concomitant disease of the mitral or aortic valve, or both, operated on between 1987 and 1999.Methods. We studied 232 consecutive patients (mean age, 59.8 years) followed for a mean of 6.8 years (range, 2 to 12 years). All patients were investigated by means of Doppler echocardiography, with hemodynamic studies in 135. Median tricuspid insufficiency was 3+. The cause was rheumatic heart disease in 186 patients and degenerative in 46. All patients underwent suture annuloplasty (De Vega or segmental) at the time of mitral or aortic valve surgery. Tricuspid lesions were functional in. 128 patients and organic in 104.Results, The hospital and late mortality rates were 8.1% and 23.3%, respectively. These figures were independent of the type of annuloplasty performed. Predictors of hospital mortality were biologic prosthesis, renal insufficiency, time of cardiopulmonary bypass, and use of inotropic drugs. Predictors of late mortality were age older than 60 years, left ventricular ejection fraction less than 0.50, and New York Heart Association functional class IV. At 12 years, the actuarial survival rate was 50.5% +/- 6.1%, and the actuarial curve free from reoperation 75.7% +/- 7.3%. The actuarial curve for freedom from valve-related complication was 39.0% +/- 6.3% at 11 years.Conclusions. Despite the use of modern technologic advances in the diagnosis and treatment of valvular heart disease, tricuspid insufficiency continues to be a poor prognostic factor in patients with concomitant disease of the mitral or aortic valve, or both. (C) 2004 by The Society of Thoracic Surgeons.