NEJM:退行性二尖瓣关闭不全患者是否应该同时进行三尖瓣修复?

2022-01-28 MedSci原创 MedSci原创

在接受二尖瓣手术的患者中,同时接受TA的患者在2年时的主要终点事件发生率低于单独接受二尖瓣手术的患者,这是由于进展为严重三尖瓣反流的频率降低所致。三尖瓣修复导致需要更频繁地植入永久性起搏器。

三尖瓣关闭不全常见于严重退行性二尖瓣关闭不全的患者。然而,证据基础不足以决定是否在二尖瓣手术期间对中度三尖瓣反流或伴有瓣环扩张的轻度反流的患者进行三尖瓣修复。

近日,顶级医学期刊NEJM上发表了一篇研究文章,研究人员将401名因退行性二尖瓣反流而接受二尖瓣手术的患者随机分配接受或不接受三尖瓣瓣环成形术(TA)手术。该研究主要的2年终点是三尖瓣关闭不全再次手术、三尖瓣关闭不全从基线进展两个等级或存在严重三尖瓣关闭不全或死亡的复合终点。

研究人员发现接受二尖瓣手术加TA的患者的主要终点事件少于单独接受二尖瓣手术的患者(3.9% vs. 10.2%)(相对风险为0.37;95%置信区间[CI]为0.16至0.86;P=0.02)。手术加TA组的两年死亡率为3.2%,单纯手术组为4.5%(相对风险为0.69;95%CI为0.25至1.88)。手术加TA组的2年三尖瓣反流进展发生率低于单纯手术组(0.6% vs. 6.1%;相对风险为0.09;95%CI为0.01至0.69)。

2年时,两组的主要心脑血管不良事件发生率、功能状态和生活质量相似,但手术加TA组永久性起搏器植入的发生率高于单纯手术组组(14.1% vs. 2.5%;比率为5.75;95%CI为2.27至14.60)。

由此可见,在接受二尖瓣手术的患者中,同时接受TA的患者在2年时的主要终点事件发生率低于单独接受二尖瓣手术的患者,这是由于进展为严重三尖瓣反流的频率降低所致。三尖瓣修复导致需要更频繁地植入永久性起搏器。只有通过更长的随访才能确定减少三尖瓣关闭不全进展是否会带来长期的临床益处。

原始出处:
 
James S. Gammie,et al.Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation.NEJM.2022.https://www.nejm.org/doi/full/10.1056/NEJMoa2115961

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    2022-01-29 ms6000000315019678

    学习了

    0

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    2022-01-29 查查佳佳

    其理论上的肠道选择性可能会降低肠

    0

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    2022-01-29 wwzzly
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