右心室功能障碍对二尖瓣手术患者临床预后的预测价值

Mohamed M. El Fiky, Yasser M. El Nahas, Faisal A. Mourad, Ihab A. Ali, Hussein A. Z. Khalifa
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摘要

背景:心脏手术后有 40% 至 60% 的人报告有术后右心室功能障碍 (RVD),这是室间隔功能下降(矛盾性室间隔运动)的一种表现。目的和目标研究 RVD 与二尖瓣介入心脏手术结果之间的关系,包括术后 3 个月内的发病率和死亡率。患者和方法:前瞻性观察比较评估共纳入47例患者,分为两组,第一组(高风险组三尖瓣环平面收缩期偏移(TAPSE)小于1.6)和第二组(低风险组TAPSE大于1.6)。研究于 2019 年 8 月至 2021 年 8 月在艾因夏姆斯大学国家心脏研究所(NHI)和心胸外科进行。研究结果两组在年龄、性别、体重指数(BMI)、二尖瓣病变、机械通气时间、重症监护室住院时间、术后出血发生率、术后出血量、并发症综合终点、并发症类型或重症监护室住院时间等方面均无显著差异。在 3 个月的评估中发现,高风险组的 TAPSE 评分明显较低(P<0.001)。多变量回归分析结果显示,只有术前 TAPSE 和交叉钳夹时间这两个变量在预测全因死亡风险方面具有统计学意义。结论通过全面的术前超声心动图评估可以发现 RV 功能障碍。通过识别术前 RV 功能障碍,可以减少手术不良事件和死亡率。
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Prognostic value of right ventricular dysfunction on clinical outcomes for patients undergoing surgical interventions for mitral valve
Background: Between 40 and 60% of individuals following cardiac surgery report having postoperative right ventricular dysfunction (RVD), which is a manifestation of decreased septal function (paradoxical septal motion). Aim and objectives: To investigate the association between RVD and the outcome of cardiac surgery for mitral valve intervention including morbidity and mortality up to 3 months after surgery. Patients and Methods: A total of 47 patients were included in the prospective observational comparative evaluation, which was split into two groups, group 1 [high risk group tricuspid annular plane systolic excursion (TAPSE) less than 1.6] and group 2 (low risk group TAPSE more than 1.6). The study took place from August 2019 to August 2021 at the National Heart Institute (NHI) and the Cardiothoracic Surgery Department of Ain Shams University. Results: There were nonsignificant differences demonstrated between the groups in terms of age, gender, body mass index (BMI), mitral pathology, the duration of mechanical ventilation, ICU length of stay, the incidence of postoperative bleeding, the volume of postoperative bleeding, the composite endpoint of complications, the type of complication, or the lengths of ICU stay. The high-risk group’s TAPSE scores were found to be considerably lower at the 3-month evaluation ( P<0.001 ). Only two variables, preoperative TAPSE and cross-clamp time, were found to be statistically significant in predicting the risk of all-cause death, according to the findings of the multivariate regression analysis. Conclusion: RV dysfunction was detected by a thorough preoperative echocardiographic evaluation. Reducing surgical adverse events and mortality may be possible with the identification of preoperative RV dysfunction.
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