【摘要】 目的回顾性分析再次三尖瓣置换患者的资料并进行随访,明确手术的危险因素及长期疗效。方法选择2000年至2010年在广东省人民医院行再次三尖瓣置换术的患者19例,男6例,女13例,年龄(41.5±11.5)岁。第一次手术时置换人工机械瓣12例,置换人工生物瓣7例。再次手术:单纯行三尖瓣置换16例,三尖瓣置换加二尖瓣成形1例,三尖瓣置换加主动脉瓣探查1例,三尖瓣置换加二尖瓣成形及Bentall术1例。置换机械瓣和生物瓣患者两次手术间隔时间分别为6个月~17年和2个月~13年,中位时间分别为5年和7年。结果再次手术植入生物瓣12例,植入双叶机械瓣7例。手术死亡2例(10.5%),分别死于多脏器功能衰竭和金葡菌败血症。存活出院的17例患者随访时间为(5.2±2.9)年,时间范围为8个月至12年。随访期间死亡2例,1例于术后半年死于消化道出血,另1例于术后2年死于右心功能衰竭。再次手术后出现Ⅲ度房室传导阻滞植入永久性起搏器1例,需要长期服用强心利尿药物治疗5例。与存活组相比,死亡组心胸比与右心室直径明显增大,差异有统计学意义[0.7±0.17 vs.0.6±0.65,P=0.023;(67±7.7)mm vs.(54±8.8)mm,P=0.021]。存活组与死亡组年龄、两次手术间隔时间、左心室射血分数、心功能分级、肺动脉压和血清肌酐、总胆红素浓度等比较,差异无统计学意义(P>0.05)。结论三尖瓣人工瓣膜功能障碍积极行再次手术治疗可获得满意的治疗效果,心胸比>0.7、右心室扩大右心功能不全是三尖瓣再次置换术的独立危险因素。更多还原

【Abstract】 Objectives To retrospectively study the medical records of patients underwent tricuspid valve re-replacement in order to identify the risk factors and outcomes of re-replacement of tricuspid valve. Methods Between 2000 and2010, 19 patients(6 males, 13 females; mean age(41.5±11.5) years, range : 19-66 years) underwent re-replacement of tricuspid valve at Guangdong Cardiovascular Institute. In initial operation,mechanical prosthetic valvses were implanted in 12 patients and bioprosthetic valves in 7 patients. Sixteen patients underwent isolated re-replacement of tricuspid valve, 1 unerwent re-replacement of tricuspid valve plus mitral valvuloplasty, re-replacement of tricuspid valve plus aortic valve exploration in 1 patients and re-replacement of tricuspid valve plus mitral valvuloplasty plus Bentall procedure in 1 patients,respectively. Interval duration between the initial and second operation was 6 months to 7 years(median 5 years) in patients with mechanical prosthetic valve and 2 months to 13 years(median 7 years) in patients with bioprosthetic valve. Results Bioprosthetic valves were implanted in 12 patients and mechanical prosthetic valves in7 patients. Two patients(10.5%) died in-hospital, 1 from multiple organ failure and 1 from staphylococcus aureus sepsis, respectively. All 17 patients discharged from hospital were followed-up completely. The mean duration of follow-up was(5.2±2.9)years(range from 8 months to 12 years). Late death occurred in 2 patients, one patient died from hemorrhage of digestive tracth half a year later, the other one died from right heart failure 2 years later. One patient was implanted permanent pacemaker after re-replacement due to Ⅲ degree atrioventricular block and 5 patients needed oral digitalis and diuretic after surgery. Compared with survival patients, died patients had higher cardiothoracic ratio(0.7 ±0.17 vs. 0.6 ±0.65, P =0.023) and enlargement of right ventricle [(67 ±7.7) mm vs.(54 ±8.8) mm, P =0.021 ]. There were no differences in age, interval duration between initial and second surgery, left ventricular ejection fraction, New York Heart Association(NYHA) classification grading of cardiac function, pulmonary artery pressure, serum creatinine and total bilirubin between the two groups. Conclusions The outcomes of re-replacement of tricuspid prosthetic valve dysfunction are proved to be acceptable. The cardiothoracic ratio >0.7 and right ventricular enlargement leading to right heart dysfunction were risk factors for tricuspid valve re-replacement.更多还原