Mid-term and Long-term Outcomes of Posterior Plication Annuloplasty(Modified Davila Annuloplasty) for Functional Tricuspid Regurgitation

기능성 삼첨판막부전증에 대한 삼첨판후판륜주름술(Davila Technique)의 중장기결과

  • Lee, Mi-Kyung (Department of Thoracic and Cardiovascular Surgery, Wonkwang University Hospital, Wonkwang University School of Medicine) ;
  • Kim, Jong-Hun (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School) ;
  • Kim, Min-Ho (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School) ;
  • Jo, Jung-Ku (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School) ;
  • Choi, Jong-Bum (Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Hospital, Chonbuk National University Medical School)
  • 이미경 (원광대학교 의과대학 부속병원 흉부외과학교실) ;
  • 김종헌 (전북대학교 의과대학 전북대병원 흉부외과학교실) ;
  • 김민호 (전북대학교 의과대학 전북대병원 흉부외과학교실) ;
  • 조중구 (전북대학교 의과대학 전북대병원 흉부외과학교실) ;
  • 최종범 (전북대학교 의과대학 전북대병원 흉부외과학교실)
  • Published : 2008.10.05

Abstract

Background: Many types of tricuspid annuloplasty are used in surgical correction of functional tricuspid regurgitation (FTR). We evaluated the mid-term and long-term outcomes in patients treated with a posterior annular plication technique (a modified Davila technique) for FTR. Material and Method: Between January 1991 and August 2006, 58 adult patients (male, 22; female, 36) with FTR of grade 2/4 or more or with tricuspid annular dilatation of more than 5.0cm in diameter, even with an FTR of less than grade 2, had received a posterior annular placation. Preoperatively, 26 patients (44.8%) had a grade 3 or more FTR. All patients had received a mitral valve replacement, and 20 (34.5%) had concomitant aortic valve replacement. Result: During the mean follow-up period of $101.4{\pm}51.6$ months, FTR disappeared or remained trivial in 28 patients (49.1%), was grade $2{\sim}3$ (${\geq}$grade 2 and $2.66{\pm}0.73\;vs.\;0.82{\pm}0.89$; p<0.0001). Patients did not require a second surgery for FTR and did not show further FTR aggravation. Conclusion: The modified Davila posterior annular plication technique for FTR has reasonable mid-term and long-term results and is a useful surgical procedure.

배경: 기능성 삼첨판막부전증의 수술치료에 여러 방법의 판륜성형술이 이용된다. 저자들은 기능성 삼첨판막부전증에 삼첨판후판륜주름술(posterior annular plication technique; Davits technique)을 이용하고 그 중장기결과를 알아보았다. 대상 및 방법: 1991년 1월부터 2006년 8월까지 기능성 삼첨판부 전정도가 2도(판막부전 범위, $1{\sim}4$도) 이상이거나 판막부전증이 2도 미만이더라도 삼첨판판륜이 직경 5.0cm 이상으로 늘어난 58예의 성인환자들(남, 22예; 여, 36예)에서 후판륜주름술을 시행하였다. 수술 전 26예(44.9%)가 3도 이상의 기능성 삼첨판부전증을 가지고 있었다. 모든 환자에서 승모판막치환술이 시행되었고 이 중 20예(34.5%)는 대동맥판막치환술도 같이 시행되었다. 결과: $101.4{\pm}51.6$개월의 추적기간 동안에 기능성 삼첨판막부전증은 28예(49.1%)에서 거의 완전히 소실되거나 흔적만 보였고, 8예(14.0%)에서 2도 이상 3도 미만을 보였으며, 2예(3.5%)에서는 3도의 삼첨판막부전을 보였다. 모든 환자에서 수술 전에 비해 수술 후 삼첨판막 부전정도는 평균 $2.66{\pm}0.73$에서 $0.82{\pm}0.89$로 호전되었다(p<0.0001). 삼첨판막에 대한 재수술이나 판막부전 정도가 수술 전보다 더 악화된 예는 없었다. 결론: 기능성 삼첨판막부전증에 대한 변형식 Davila 후판륜주름술은 의의 있는 중장기적 결과를 보였으며 유용한 수술방법으로 생각된다.

Keywords

References

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