Short-term outcomes of minimally invasive reoperation for tricuspid regurgitation after left-sided valve surgery
10.3760/cma.j.issn.0529-5815.2019.12.005
- VernacularTitle: 微创三尖瓣手术治疗左心瓣膜术后三尖瓣关闭不全的近期疗效分析
- Author:
Shun LIU
1
;
Jinmiao CHEN
;
Wenshuo WANG
;
Yuntao LU
;
Yang MING
;
Lai WEI
;
Chunsheng WANG
Author Information
1. Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Disease, Shanghai 200032, China
- Publication Type:Journal Article
- Keywords:
Tricuspid regurgitation;
Cardiac surgical procedures;
Reoperation;
Surgical procedures, minimally invasive
- From:
Chinese Journal of Surgery
2019;57(12):898-901
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To examine the short-term outcomes of minimally invasive reoperation for severe tricuspid regurgitation after left-sided valve surgery.
Methods:From January 2015 to December 2018, a total of 89 patients with severe tricuspid regurgitation after left-sided valve surgery received reoperation in Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University were included in this study. There were 21 males and 68 females, aging of (56.4±7.9) years (range: 41 to 74 years). The interval between previous left-sided valve surgery and tricuspid reoperation was (14.1±6.1) years (range: 4 to 33 years). A combination of multiple minimally invasive techniques were adopted, including endoscopy-assist right minithoracotomy approach, peripheral cannulation strategy with the vacuum-assist single venous drainage technique, heart beating technique, and temporary percutaneous pacemaker implantation, with a concomitant enhancement in preoperative right cardiac function optimization.
Results:All patients received minimally invasive isolated tricuspid valve replacement (n=81) or tricuspid valve repair (n=8). After the application of multiple minimally invasive techniques, the operative mortality rate was only 3.4% (3/89). The causes of death were progressive right heart failure with multiorgan failure (n=1) and low cardiac output associated with postoperative bleeding (n=2). Regarding to the perioperative complications, renal replacement therapy rate was 5.6% (5/89), permanent pacemaker implantation rate was 1.1% (1/89), and the incidence of stroke was 0. Mechanical ventilation time was 24(24) hours, ICU stay time was 2.5 (3.0) days (M(QR)). During the short-term follow-up, there were no case of severe tricuspid regurgitation, 2 cases of moderate regurgitation, 4 cases of mild-to-moderate regurgitation.
Conclusions:For severe tricuspid regurgitation after left-sided valve surgery, the advanced minimally invasive techniques can significantly reduce the operative mortality and morbidity. Minimally invasive bioprosthetic tricuspid valve replacement is a reliable alternative for severe tricuspid regurgitation after left-sided valve surgery.
