左心瓣膜术后三尖瓣反流诊疗中国专家共识2022版

中华胸心血管外科杂志2023年5月第39卷第5期Chin】Thorae Cardiovase Surg,Mw2023,Vol.39No.5265指南·共识·规范左心瓣膜术后三尖瓣反流诊疗中国专家共识(2022版)国家心血管病专家委员会微创心血管外科专业委员会通信作者：王春生Email:wang.chunsheng@s-hospital.sh.cn魏来wei.lai@zs-hospital.sh.cn【摘要】左心瓣膜术后远期可发生三尖瓣反流。左心瓣膜术后单纯三尖瓣反流是指在二尖瓣和/或主动脉瓣置换或成形术后远期出现单纯三尖瓣反流，而左心瓣膜不存在需要再次干预的显著病变。由于严重的三尖瓣反流影响患者的长期预后，因此需要再次外科或介入手术治疗。然而，目前瓣膜指南中对于左心瓣膜术后单纯三尖瓣反流再次行三尖瓣手术干预的时机和方式尚无明确建议。当前多种微创外科技术和介入治疗的应用可能降低了三尖瓣手术的病死率。为进一步加深对左心瓣膜术后单纯三尖瓣反流的理解、规范治疗，改善预后、促进协作，国家心血管病专家委员会微创心血管外科专业委员会牵头从发病机制、术前评估、手术干预指证、外科手术、介入手术，围手术期管理等方面撰写了本专家共识。D0I:10.3760/cma.j.cnl12434-20230425-000972022 CMICS expert consensus on the management of isolated tricuspid regurgitation after left-sided valve surgeryChinese Minimally Invasive Cardiovaseular Surgery CommitteeCorresponding author:Wang Chunsheng Email:ang.chunshengs-hospital.h.cnWei Laiwei.lai@zs-hospital.cn[Abstract ]Tricuspid rition(TR)may occur late after left-sided valve surgery(LSVS).bolated tricuspid regugita-tion afier left-sided valve surgery(iTR-LSVS)refers to isolted TR without significant lesions in the mitral ad or aortic posi-tion late after mitral and/or aortic replacement or repair.Severe TR has a negative impact on long-term prognosis and requiressurgical or transcatheter treatment.However,there is no elear recommendation on when and bow intervention should be per-formed for patients with iTR-LSVS in the current guidelines for the management of valvular heart disease.The historically highoperative mortality may be reduced by current minimally invasive techniques and transcatheter therapy.To further understandiTR-ISVS,standardize the treatment,improve the psand promote the collaboration,the Chinese Minimally InvasiveCardiovascular Surgery Committee(CMICS)wrote this expert cone the managment of iTR-ISVS from the aspeets of etiobgy,preoperative evaluation,indications for intervention,surgical treatment transcatheter therapy,and postoperative man-D01:10.3760/ma.j.ml12434-20230425-00097随着心脏外科的不断发展，越来越多的左心瓣瓣置换或成形术后远期出现单纯三尖瓣反流，而左膜疾病通过手术得到了有效的治疗。研究发现，部心瓣膜不存在需要再次干预的显著病变。由于严重分患者在远期随访过程中可出现三尖瓣反流(t的三尖瓣反流会导致右心衰竭、肝肾功能受损、体循cuspid regurgitation,TR)。左心瓣膜术后单纯三尖环淤血等并发症，影响患者的长期预后，往往需要再瓣反流(isolated tricuspid regurgitation after left--sided次手术干预。valve surgery,iTR-LSVS)是指在二尖瓣和/或主动脉当前瓣膜指南中对于TR-LSVS患者再次行三尖瓣手术干预的时机和方式尚无明确建议1)。以本文首次发表在Reviews in Cardiovascular Medicine》2O23年第24往单纯三尖兼手术(isolated tricuspid valve surgery,卷第5期第129页，htps://i:g/10.31083/八.rm2405129。本文是iTVS)的病死率通常在10%左右5-)。尽管缺乏高(2022 CMICS expert consensus on the management of isolated tricuspid re-质量的前瞻性研究数据，多种微创外科技术的应用gurgitation after left--sided valve sugery》文章的二次发表（全译）。可能降低了手术病死率和并发症发生率1-)。近