【摘要】 目的 探讨三尖瓣反流（tricuspid regurgitation, TR）对经导管二尖瓣瓣中瓣置换术（transcatheter mitral valve-in-valve replacement, TM-ViV）患者预后的影响以及术后的TR的转归，为接受再次二尖瓣手术的患者探究合适的手术方案。方法 回顾性分析2020年3月至2023年9月在广东省人民医院接受TM-ViV手术的94例患者的临床资料。根据术前TR程度分为无或轻度TR组（25例）和中或重度TR组（69例）。结果 无或轻度TR组中有3例患者（12.0%）在术后1个月时TR加重为中度或重度，在中或重度TR组中，术后1个月时38例患者（58.5%）TR程度降低，27例患者（41.5%）TR严重程度无变化。随访时间为（31.4±11.8）个月，共20例患者死亡，其中无或轻度TR组5例（20.0%），中或重度TR组15例（21.7%）(P=0.819)。多因素分析提示TR程度不是中期死亡的危险因素（P>0.05）。结论 术前TR的程度不是TM-ViV手术患者中期死亡的危险因素，可以保守处理TR,TM-ViV可行。更多还原

【Abstract】 Objectives To investigate the impact of tricuspid regurgitation(TR) on the prognosis of patients undergoing transcatheter mitral valve-in-valve replacement(TM-ViV) and the postoperative progression of TR, aiming to explore optimal surgical strategies for patients requiring repeat mitral valve procedures. Methods Clinical data from 94 patients who underwent TM-ViV in Guangdong Provincial People’s Hospital from March 2020 to September 2023 were retrospectively analyzed. Patients were stratified into no or mild TR(n=25) group and moderate or severe TR(n=69) group based on preoperative TR severity. Results In no or mild TR group, 3 patients(12.0%) progressed to moderate or severe TR at 1 month postoperatively. In moderate or severe TR group, TR severity reduced in 38 patients(58.5%), while 27 patients(41.5%) showed no change in TR severity. During a follow-up of(31.4±11.8) months, 20 deaths occurred [no or mild TR group: 5(20.0%) vs. moderate or severe TR group: 15(21.7%), P=0.819). Multivariate analysis confirmed TR severity was not a risk factor for mid-term mortality(P>0.05). Conclusions Preoperative TR severity does not predict mid-term mortality in TM-ViV patients, supporting conservative TR management. TM-ViV remains a feasible intervention.更多还原