| Objective: To provide a new surgical method for the clinical treatment of secondary tricuspid regurgitation by comparing the surgical effects of pericardial soft annulus forming tricuspid valve with Devega forming and artificial annuloplasty.Methods: From January 2013 to December 2021,382 patients with secondary tricuspid regurgitation who underwent cardiothoracic surgery in XXX due to rheumatic heart disease(RHD)were retrospectively analyzed.For example,the central package soft ring group(n=139 cases),Devega group(n=131 cases),artificial valve ring group(n=112 cases),through propensity score matching(PSM)method,balanced The confounding factors in each group of patients were matched according to 1:1 and divided into pericardial soft ring group and artificial valve ring group(matching A,a total of 128 cases),pericardial soft ring group and Devega group(matching B,a total of 174 cases),successfully matched Cases were enrolled and followed up and collected case data.After matching,the length of operation,extracorporeal circulation,and stay in the intensive care unit of the patients after 1 month,6months,24 months,48 months,and 96 months The number of days,the duration of using the ventilator,electrocardiogram,echocardiographic results(diastolic tricuspid valve ring diameter,tricuspid regurgitation area/right atrial area,right ventricular diameter,right atrial diameter,etc.)and survival rate were statistically analyzed.Results: After applying propensity score matching,a total of 302 patients were successfully matched,64 pairs of cases were matched in A,and 87 pairs of cases were matched in B.The differences in these baseline characteristics were balanced after matching.Matching A has completed follow-up of 41 pairs of cases 6 months after operation,and matching B has completed follow-up of 47 pairs of cases;24 months after operation,matching A has completed follow-up of 30 pairs of cases,and matching B has completed follow-up of 38 pairs of cases;Matching A completed follow-up of 14 pairs of cases within one month,and matching B completed follow-up of 28 pairs of cases;96 months after surgery,matching A completed follow-up of 7 pairs of cases,and matching B completed follow-up of11 pairs of cases.The results of echocardiography 6 months after the operation showed that the differences in RAD and RVD between the two groups in matching A were statistically significant(P<0.05),and the remaining variables were not statistically significant(P>0.05);the two groups in matching B The difference in RAD was statistically significant(P<0.05),and the remaining variables were not statistically significant(P>0.05).At 24 months after operation,the echocardiography showed that the differences in pressure difference halving time,RAD,and RVD between the two groups in matching A were statistically significant(P<0.05),and the remaining variables were not statistically significant;There were no significant differences in cusp pressure gradient,mitral valve blood flow velocity,TR area,pressure gradient halving time,average RAD,and average RVD(P>0.05).Color Doppler echocardiography at 48 months after operation showed that there were statistically significant differences in mitral valve blood flow velocity,pressure halving time,tricuspid regurgitation area,and average RVD between the two groups in matching A(P<0.05).There was no significant difference in cusp valve pressure difference and average RAD(P>0.05);there were statistically significant differences in mitral valve flow velocity and tricuspid regurgitation area between the two groups in matching B(P<0.05),There was no statistically significant difference in the variables(P>0.05);96 months after the operation,the echocardiography showed that there were statistically significant differences in the pressure difference halving time and tricuspid regurgitation area between the two groups in matching A(P<0.05),there was no significant difference in residual variables(P>0.05);in matching B,there were statistically significant differences in mitral valve flow velocity,tricuspid regurgitation area,and average RAD between the two groups(P<0.05).Conclusion: During the follow-up period of 96 months after operation,the degree of right heart reverse remodeling,the area of tricuspid regurgitation and the occurrence of PPM phenomenon of pericardial soft annuloplasty tricuspid valve were better than artificial annuloplasty tricuspid valve,Devega Tricuspid regurgitation has been improved to varying degrees.Therefore,pericardial soft ring annuloplasty has a relatively positive effect on the treatment of secondary tricuspid regurgitation,and provides a surgical method for the treatment of tricuspid regurgitation. |
PDF Full Text Request