| Objective: The purpose of this study is to find out that whether the modified De Vega suture annuloplasty could prevent mild functional tricuspid regurgitation from progressing by means of analyzing surgical results and to preliminarily discuss risk factors which may cause regurgitation progression.Methods: Collecting data about 1476 patients(pts) who have underwent Mitral valve replacement in cardiovascular surgery of Guizhou Province People’s Hospital from 2008 March to 2013 December,160 pts of them complicate with mild functional tricuspid regurgitation. According to the operation scheme,the 160 pts were separated into two groups, Concurrent processing groups(the modified De Vega annuloplasty was implemented during the operation) and Non-concurrent processing groups. Comparative analysis statistical difference of clinical data in two groups(gender, age, weight, valvular etiology data, cardiothoracic ratio, NYHA cardiac functional grading, cardiopulmonary bypass time, aortic clamping time, postoperative mechanical ventilation time, ICU monitoring time, postoperative drainage volume 24 h, postoperative hospitalization time,postoperative complications). Collecting echocardiographic data(tricuspid regurgitation,tricuspid annulus diameter, heart chamber size, left ventricular systolic function,pulmonary artery systolic pressure) at preoperative, postoperative, 1 year late.Comparative analysis statistical difference of the echocardiographic data. Find out risk factors which may cause regurgitation progression by means of multiple factor analysis.Result:1. All of the 160 pts have underwent operation successfully and recovered. 150pts(94%)of those have completed the follow-up investigation after operation; Other 10 pt have not completed the follow-up investigation after operation(4pts complicated with cerebral vascular accident,2pts died because of it).2. CP group include 109pts; female 74 pts, male 35pts; 34~59 years old(average43.75±8.76 years); weight 39~84 kg(average 53.61±9.23 kg);cardiothoracic ratio 0.51~0.76(average0.63±0.06); valvular etiology : rheumatic heart valve disease 80pts(73%), non- rheumatic heart valve disease 29pts(27%); NYHAⅢ 94 pts, NYHA Ⅳ 15 pts. NCP group include 41pts; female 24 pts, male 17pts;28~66 years old(average48.66±11.42 years); weight 37~73 kg(average 54.03±9.51kg); cardiothoracic ratio 0.47~0.75(average0.60±0.05); valvular etiology : rheumatic heart valve disease 13pts(32%), non-rheumatic heart valve disease 28pts(68%);NYHA Ⅲ 36 pts, NYHA Ⅳ 5pts.All of 150 pts are atrial fibrillation. There is no significant difference, between two group, in gender, age, weight, cardiothoracic ratio,NYHA cardiac functional grading(P>0.05);there is significant difference in valvular etiology(P<0.05). Rheumatic heart disease accounted for 73% in CP group and accounted for only 32% in NCP group.3. CP group: cardiopulmonary bypass time 74.87±19.99min; aortic clamping time53.81±15.49 min, postoperative mechanical ventilation time 8.93±2.83 h, ICU monitoring time 20.52±5.61 h, postoperative drainage volume 24 h 461.42±225.73 ml,postoperative hospitalization time 10.45±1.98 days; NCP group: cardiopulmonary bypass time 76.59±20.75min; aortic clamping time 55.05±15.29 min, postoperative mechanical ventilation time 8.66±2.72 h, ICU monitoring time 20.48±4.86 h,postoperative drainage volume 24 h 445.86ml±226.68 ml, postoperative hospitalization time 11.03±1.60 days; There is no significant difference, between two group, in the above indexes(p>0.05).4. Preoperatively, the cardiac function indexes of UCG: CP group: left ventricular ejecting fraction 0.52±0.11, Left ventricular fractional shortening 0.33±0.05; NCP group: left ventricular ejecting fraction 0.57±0.08, Left ventricular fractional shortening 0.31±0.07;Preoperatively, there is no significant difference, between two group, in Left ventricular fractional shortening(p>0.05), but the left ventricular ejecting fraction of CP group is higher than NCP group significantly(p<0.05).5. Postoperatively, the cardiac function indexes of UCG: CP group: left ventricular ejecting fraction 0.63±0.13, Left ventricular fractional shortening 0.32±0.03; NCP group: left ventricular ejecting fraction 0.64±0.09, Left ventricular fractional shortening 0.31±0.04; Postoperatively, there is no significant difference, between two group, in the cardiac function indexes of UCG(p>0.05).6. Comparison of the cardiac function indexes of UCG within group: there is no significant difference, within CP group, in Left ventricular fractional shortening(p>0.05), but the preoperative left ventricular ejecting fraction of CP group is higher than postoperative index(p<0.05); the comparison within NCP group have same results.7. Heart chamber size of UCG: preoperatively, CP group: LV 53.49±4.66 mm, RV23.69±4.72 mm, LA 55.12±12.35 mm, RA 47.92±9.04mm; NCP group: LV52.18±7.11 mm, RV 22. 74±3.23 mm, LA 47.45±9.89 mm, RA 49.16±8.43 mm.Postoperatively, CP group: LV 44.38±7.92 mm, RV 17.76±3.04 mm, LA46.44±10.17 mm, RA 38.43±6.77mm; NCP group: LV 44.96±5.87 mm, RV21.66±3.55 mm, LA 44.99±11.06 mm, RA 48.66±7.12 mm. Comparison of the heart chamber size between two group: preoperatively, there is no significant difference in LV, RV, RA(p>0.05), but the LA of CP group is significantly larger than NCP group(p<0.05);postoperatively, the RV and RA of CP group is significantly smaller than NCP group(p<0.05). Comparison within group: there is significant difference,within CP group, in four heart chamber size(p<0.05); there is no significant difference,within NCP group, in RA and RV(p>0.05), but the postoperative LV and LA of NCP group is significantly smaller than preoperative indexes(p<0.05).8. Preoperative pulmonary artery systolic pressure: CP group 34.29±16.63 mm Hg, NCP group 26.96±17.06 mm Hg; the pulmonary artery systolic pressure of NCP group is significantly higher than CP group(p<0.05).9. Tricuspid annulus diameter of CP group: preoperatively 32.46±3.72 mm,postoperatively 29.06±4.96 mm, 1 years of follow-up 29.44±5.06mm; NCP group:31.12±3.69 mm,29.39±5.08 mm,41.42±6.93 mm. Comparison between two group: there is no significant difference in preoperative and postoperative tricuspid annulus diameter(p>0.05),but after 1 years of follow-up, the tricuspid annulus diameter of NCP group is significantly larger than CP group(p<0.05). Comparison within group: there is no significant difference in tricuspid annulus diameter of CP group(p>0.05),but the follow-up tricuspid annulus diameter of NCP group is significantly larger than postoperative index(p<0.05).10. Preoperatively, All 150 pts complicate with mild functional tricuspid regurgitation.Postoperatively, CP group:64pts have no tricuspid regurgitation, 45 pts have mild tricuspid regurgitation, NCP group:8pts have no tricuspid regurgitation, 33 pts have mild tricuspid regurgitation. After 1year follow-up, CP group: 61 pts have no tricuspid regurgitation, mild 48 pts, NCP group: only 1pts have no tricuspid regurgitation, mild26 pts, moderate 14 pts. There is no significant difference, within CP group, in the tricuspid regurgitation(p>0.05). After 1year follow-up, the tricuspid regurgitation of NCP group is more serious than before(p<0.05),the tricuspid regurgitation of NCP group has progressed.11. Inplement the logistic regression analysis of related factors, we find out that the preoperative pulmonary artery systolic pressure and rheumatic heart valve disease could be the risk factor which may cause regurgitation progression(p<0.05 and OR>1).Conclusion:1. The modified De Vega suture annuloplasty would not increase operation risk and incidence of perioperative complications.2. The modified De Vega suture annuloplasty could prevent mild functional tricuspid regurgitation from progressing.3. The preoperative pulmonary artery systolic pressure and rheumatic heart valve disease could be the risk factor which may cause regurgitation progression.4. To decide whether should patient undergo tricuspid valve plasty, according to the three degree of tricuspid regurgitation alone, is not advisable. |
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