作者：孔强强，马宁，刘东海，张亮，赵立轩，乔晨晖

单位：

450052河南省郑州市，郑州大学第一附属医院心血管外科

Units：

Department of Cardiovascular Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China

关键词：

二尖瓣关闭不全；三尖瓣反流；二尖瓣成形术；三尖瓣成形术；治疗结果

Keywords：

Mitral valve incompetence; Tricuspid regurgitation; Mitral valve annuloplasty; Tricuspid valvuloplasty;Treatment outcome

CLC：

R 542.51

DOI：

10.12114/j.issn.1008-5971.2023.00.244

Funds：

河南省医学科技攻关计划项目（SBGJ202003049）

摘要：

　目的　探讨二尖瓣成形术（MVP）同期行三尖瓣成形术（TVR）治疗退行性二尖瓣关闭不全（DMR）合并轻中度三尖瓣反流（TR）的临床效果。方法　选取2016年7月至2020年7月郑州大学第一附属医院收治的DMR合并轻中度TR患者145例为研究对象，根据是否接受MVP同期行TVP将所有患者分为MVP+TVP组（n=63）和MVP组（n=82）。比较两组患者手术前后超声心动图检查结果、Ⅲ度房室传导阻滞发生率、NYHA分级≥Ⅲ级者占比。随访2年，终点事件为患者进展为中重度/重度TR。采用Kaplan-Meier法绘制两组术后进展为中重度/重度TR的生存曲线，采用多因素Cox风险比例回归分析探讨DMR合并轻中度TR患者术后进展为中重度/重度TR的影响因素。结果　MVP+TVP组术前右心室舒张末期内径（RVEDD）大于MVP组（P＜0.05）。MVR+TVP组术后肺动脉收缩压（PASP）低于MVP组，三尖瓣环径（TAD）小于MVP组，Ⅲ度房室传导阻滞发生率高于MVP组（P＜0.05）；MVP+TVP组术后进展为中重度/重度TR率低于MVP组（P＜0.05）。生存曲线分析结果显示，MVP+TVP组术后累积进展为中重度/重度TR率低于MVP组（P＜0.05）。多因素Cox比例风险回归分析结果显示，术前中度TR、心房颤动、术前TAD＞40 mm及同期行TVP是DMR合并TR患者术后进展为中重度/重度TR的独立影响因素（P＜0.05）。结论　MVP同期行TVP可有效延缓DMR合并轻中度TR患者术后TR进展，降低PASP，但会增加患者Ⅲ度房室传导阻滞发生率；且术前中度TR、心房颤动、术前TAD＞40 mm是DMR合并轻中度TR患者术后进展为中重度/重度TR的危险因素，而同期行TVP是其保护因素。

Abstract：

Objective To investigate the clinical effect of mitral valvuloplasty (MVP) combined with tricuspidvalvuloplasty (TVR) in the treatment of patients with degenerative mitral regurgitation (DMR) and mild to moderate tricuspidregurgitation (TR) . Methods A total of 145 DMR patients complicated with mild to moderate TR admitted to the FirstAffiliated Hospital of Zhengzhou University from July 2016 to July 2020 were selected as the research objects. According towhether MVP combined with TVP were performed at the same time, all patients were divided into MVP+TVP group (n=63)and MVP group (n=82) . The results of echocardiography, the incidence of Ⅲ degree atrioventricular block and the proportionof patients with NYHA grade ≥ Ⅲ were compared between the two groups before and after operation. After 2 years of followup, the endpoint was progression to moderate to severe/severe TR. Kaplan-Meier method was used to draw the survival curve ofprogression to moderate to severe/severe TR in the two groups after operation. Multivariate Cox proportional hazard regressionanalysis was used to explore the influencing factors of postoperative progression to moderate to severe/severe TR in DMRpatients combined with mild to moderate TR. Results The preoperative right ventricular end diastolic diameter (RVEDD) inthe MVP+TVP group was larger than that in the MVP group (P < 0.05) . The postoperative pulmonary artery systolic pressure(PASP) in the MVR+TVP group was lower than that in the MVP group, the tricuspid annulus diameter (TAD) was smaller thanthat in the MVP group, and the incidence of Ⅲ degree atrioventricular block was higher than that in the MVP group (P < 0.05) .The incidence of progression to moderate to severe/severe TR after operation in MVP+TVP group was lower than that in MVP group (P < 0.05) . The survival curve analysis showed that the cumulative incidence of progression to moderate to severe/severeTR after operation in the MVP+TVP group was lower than that in the MVP group (P < 0.05) . Multivariate Cox proportional hazardregression analysis showed that preoperative moderate TR, atrial fibrillation, preoperative TAD > 40 mm and undergoing TVP atthe same time were independent influencing factors for postoperative progression to moderate to severe/severe TR in DMR patientscombined with mild to moderate TR (P < 0.05) . Conclusion MVP combined with TVP at the same time can effectively delaythe progression of TR and reduce PASP in DMR patients combined with mild to moderate TR, but it will increase the incidenceof Ⅲ degree atrioventricular block. Preoperative moderate TR, atrial fibrillation, preoperative TAD > 40 mm are risk factors forpostoperative progression to moderate to severe/severe TR in DMR patients combined with mild to moderate TR, while undergoingTVP at the same time is a protective factor for it.

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