三尖瓣手术中心脏跳动技术与主动脉交叉钳夹的比较

Yüksel Dereli, Ömer Tanyeli, Mehmet Işık, Özgür Altınbaş, Serkan Yıldırım, Volkan Burak Taban, Veli Eşref Karasu
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摘要

目的:三尖瓣手术可以在跳动的心脏上进行,也可以在停止跳动的心脏上进行。我们旨在比较使用这两种不同方法进行三尖瓣手术的结果:研究纳入了 2015 年 1 月至 2020 年 2 月期间接受三尖瓣手术并同时接受心脏外科手术的 204 名患者。分别有103名和101名患者采用了交叉钳夹和搏动心三尖瓣手术技术。两组患者均在交叉钳夹术下同时进行了瓣膜和/或冠状动脉介入手术。比较了两组患者术前、术后即刻和术后六个月的结果:结果:两组患者的人口统计学特征和术前三尖瓣反流程度无差异。采用心脏跳动技术进行手术的患者机械通气时间、在重症监护室和医院的停留时间明显较短。此外,心脏跳动组患者的再次手术率和死亡率也明显较低。术后六个月的超声心动图检查结果显示,心脏跳动组的三尖瓣反流、三尖瓣最大和最小梯度以及肺动脉压也更低:结论:心脏跳动三尖瓣手术可能优于交叉钳夹技术,以避免钳夹引起的缺血,而缺血会导致术后效果恶化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of Beating-Heart Technique Versus Aortic Cross-Clamping in Tricuspid Valve Surgery.

Objective: Tricuspid valve surgery can be performed on a beating heart or on an arrested heart. We aimed to compare the outcomes of tricuspid valve surgery using these two different approaches.

Methods: Between January 2015 and February 2020, 204 patients who underwent tricuspid valve surgery along with concomitant cardiac surgical procedures were included in the study. Techniques of cross-clamping and beating-heart tricuspid surgery were applied to 103 and 101 patients, respectively. Concomitant valvular and/or coronary interventions were performed under cross clamping in both groups. Results from the preoperative period, immediate postoperative period, and six-month postoperative interval were compared between the groups.

Results: There were no differences in demographic characteristics or preoperative grades of tricuspid valve regurgitation between the groups. Duration of mechanical ventilation, and stays in the intensive care unit and hospital were significantly shorter in patients operated on using the beating-heart technique. Additionally, re-exploration surgery and mortality rates were significantly lower in the beating-heart group. Postoperative six-month echocardiography findings related to tricuspid valve regurgitation, maximum and minimum gradients of the tricuspid valve, and pulmonary arterial pressure were also lower in the beating-heart group.

Conclusion: Beating-heart tricuspid valve surgery may be preferable to the cross-clamping technique to avoid clamp-induced ischemia, which can lead to worsened postoperative outcomes.

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