中国胸心血管外科临床杂志

中国胸心血管外科临床杂志

三尖瓣置换术治疗矫正性大动脉转位患者的远期随访结果及其危险因素分析

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目的 评价三尖瓣置换术(tricuspid valve replacement,TVR)作为一种缓解症状的手术方式,治疗先天性矫正性大动脉转位(congenital corrective transposition of the great artery,CCTGA) 成年患者的远期临床效果及其危险因素。 方法 回顾性分析阜外医院 2000~2017 年间年龄>14 岁的先天性大动脉转位行三尖瓣置换术 47 例患者的临床资料。平均手术年龄 14~62(38.8±13.5)岁。术前所有患者超声均提示三尖瓣中量或以上反流。记录患者术前及术中基本资料,通过电话随访及超声复查结果统计患者生存情况。 结果 研究平均随访时间(6.5±3.7)年,患者 1 年、5 年、10 年生存率或免于心脏移植发生率分别为 94.6%、90.5%、61.7%。随访期间,大多数患者(>90%)远期右心室射血分数(right ventricular ejection fraction,RVEF)仍≥40%。术前右心室舒张期末直径(right ventricular end diastolic diameter,RVEDD)增大是术后患者死亡或心脏移植的危险因素(风险比 1∶11,P=0.04)。术前 RVEDD≥60 mm 的患者其生存率显著降低(P=0.032)。 结论 三尖瓣置换术对于成人矫正性大动脉转位患者是一种可行的治疗方式。术前右心室舒张期末直径增大是术后远期死亡率的危险因素。

Objective To evaluate the long-term clinical effect and risk factors of tricuspid valve replacement (TVR) as a relief treatment for adult patients with congenitally corrective transposition of the great artery (CCTGA). Method From 2000 to 2017, 47 patients with congenital transposition of great artery underwent tricuspid valve replacement in Fuwai Hospital. Among them, the average age of operation was 38.8±13.5 years (14–62 years). Preoperative echocardiography showed moderate or more tricuspid regurgitation in all patients. The basic data of patients before and during operation were recorded. Survival was followed up by telephone and ultrasound report. Results The average follow-up time was 6.5+3.7 years. The 1-year, 5-year and 10-year survival rates or the incidence of heart transplant-free were 94.6%, 90.5% and 61.7% respectively. During the follow-up period, the long-term right ventricular ejection fraction (RVEF) of most patients (>90%) was still greater than or equal to 40%. Increased preoperative right ventricular end diastolic diameter (RVEDD) was a risk factor for death or heart transplantation (risk ratio 1∶11,P=0.04). The survival rate of patients with right ventricular end-diastolic diameter (>60 mm) before operation was significantly reduced (p=0.032). Conclusion Tricuspid valve replacement is a feasible treatment for adult patients with corrective transposition of great arteries. The increase of preoperative right ventricular end-diastolic diameter is a risk factor for long-term mortality.

关键词: 三尖瓣置换术; 先天性心脏病; 矫正性大动脉转位

Key words: Tricuspid valve replacement; congenital heart diseases; corrective transposition of the great artery

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