Clinical Research On Early Surgical Treatment For Patients With Moderate Or Severe Tricuspid Regurgitation Secondary To Rheumatic Mitral Valve Disease

Objective:To compare the different surgical procedures for treating moderate and severetricuspid regurgitation secondary to rheumatic mitral valve malfunction and to analyzethe risk factors of affect in early postoperative heart function recovery.Method:192patients between January2013and March2013who had the mitral valvereplace surgery with rheumatic heart disease, enrolled in the study,58patients withouttricuspid regurgitation or with mild tricuspid regurgitation was subjected to the controlgroup, the rest134patients were subjected to suture annuloplasty group(62cases) andartificial valve ring annuloplasty group(72cases). We collected the clinical data of thepatients, analyzing the results of cardiac ultrasonography, hepatic and renal function,and the age, sex, pre-and intro-operative data, etc. Those data was studied withone-way analysis of variance, chi-square test, logistic regression analysis and SPSS18.0software.Result:The postoperative diameters of heart were decreased obvious in the three groups,and post-operative diameters of heart were decreased obvious in the artificial valve ringannuloplasty group than the suture annuloplasty group, The pre-operative diameter(LAD) of left atrial enlarged obvious in the suture annuloplasty group and artificialvalve ring annuloplasty group compared with he control group (P<0.05). but post-operative (two-week) and post-operative (six-month) have no difference in the threegroups(P>0.05). The pre-operative diameter (RAD) of right atrial enlarged obvious inthe suture annuloplasty group and artificial valve ring annuloplasty group comparedwith he control group (P<0.05), the post-operative (two-week) diameter (RAD) of rightatrial enlarged obvious in the suture annuloplasty group and artificial valve ringannuloplasty group compared with he control group (P<0.05),but the post-operative (six-month) diameter (RAD) of right atrial was decreased obvious in the control groupand artificial valve ring annuloplasty group compared with the suture annuloplastygroup (P<0.05), there was no difference in the artificial valve ring annuloplasty groupand control group (P>0.05). The pre-operative and post-operative (two-week) diameter(RVD) of right ventricular have no difference in the artificial valve ring annuloplastygroup and suture annuloplasty group, and larger than the control group (P<0.05), butpost-operative (six-month) ring annuloplasty group and control group have nodifference, and decreased obvious than the suture annuloplasty group. The pre-operativehepatic function index of ALT(alanine transaminase)have no difference in the threegroups, but post-operative (two-week) ALT of the suture annuloplasty group is higherthan the artificial valve ring annuloplasty group and the control group (P<0.05), it wasno difference between the artificial valve ring annuloplasty group and the control group.The result of logistic regression analysis revealed that the risk factors include age≥65,complicated with atrial fibrillation(have no maze operation), the time ofcardiopulmonary bypass (CPBT)≥160min, the left atrial diameter (LAD) ofpre-operative≥70mm, left ventricular ejection fraction(LVEF)<50%, NYHA IV ofpre-operation.Conclusion:The artificial valve ring annuloplasty is superior to the suture annuloplasty for thetreatment of the moderate or severe tricuspid regurgitation secondary to rheumaticmitral valve malfunction patients. The risk factors of affect early postoperative heartfunction recovery include: age≥65, complicated with atrial fibrillation(have no mazeoperation), the time of cardiopulmonary bypass (CPBT)≥160min, the left atrialdiameter (LAD) of pre-operative≥70mm, left ventricular ejectionfraction(LVEF)<50%, NYHA IV of pre-operation.