Minimally invasive treatment scheme of isolated tricuspid valve insufficiency after left heart valve surgery and the perioperative results

SHEN Hong; HE Xiaoyi; JIANG Shengli

doi:10.3969/j.issn.1674-3806.2024.03.03

Abstract：Objective To analyze the perioperative results of severe isolated tricuspid valve insufficiency after total thoracoscopic surgery treatment for left heart valve,and to explore the advantages and clinical effects of total tho-racoscopic surgery on reoperation for tricuspid valve.Methods The clinical data of patients with severe isolated tricuspid valve insufficiency after left heart valve surgery who received total thoracoscopic surgery treatment of tricuspid valve in Department of Cardiovascular Surgery,First Medical Center,Chinese PLA General Hospital from January 2018 to December 2023 were retrospectively collected.A total of 134 patients who met the inclusion criteria were included in this study,and their perioperative clinical data and treatment experience were summarized.Among the patients,72 cases(53.7%)underwent tricuspid valvuloplasty(tricuspid valvuloplasty group)and 62 cases(46.3%)underwent tricuspid valve replace-ment(tricuspid valve replacement group).The relevant indicators were compared between the two groups.Results The median time of cardiopulmonary bypass(CPB)in the 134 patients was 92 minutes and the mean operation time was(183.8±56.1)minutes.Two cases(1.5%)had right heart dysfunction after CPB weaning,and received extracorporeal membrane oxygenation(ECMO)support.The weaning was successful within 1 week after surgery.Blood products were transfused in 54 cases(40.3%).After surgery,the median time of ventilator-assisted ventilation was 13.0 hours.The median length of stay in the intensive care unit(ICU)was 2.0 days,and the median time of drainage tube removal was 2.0 days,and the median postoperative thoracic drainage volume was 475.0 mL.Early postoperative complications occurred in 16 cases including ventricular fibrillation in 2 cases,pleural effusion in 4 cases,admission for reoperation in 2 cases and pacemaker implantation in 8 cases.There was no early postoperative death.The pulmonary artery pressure,and the proportion of preoperative atrial fibrillation in the tricuspid valvuloplasty group were lower than those in the tricuspid valve replacement group,and the differences were statistically significant(P＜0.05).The operation time,intraoperative plasma transfusion volume,postoperative mechanical ventilation time,length of stay in ICU,postoperative drainage volume,postoperative right atrial diameter,right ventricular end-diastolic diameter,left atrial diameter and the proportion of postoperative complications in the tricuspid valvuloplasty group were lower than those in the tricuspid valve replacement group,and the differences were statistically significant(P＜0.05).There were no significant differences in the duration of CPB,intraoperative blood transfusion rate,drainage tube removal time,postoperative left ventricular end-diastolic diameter,postoperative left ventricular ejection fraction,cardiac troponin T on the second day after surgery,creatine kinase isoenzyme MB on the second day after surgery,and the utilization rates of artificial heart assistance devices(including ECMO and intra-aortic balloon pump)between the two groups(P＞0.05).Conclusion CPB with beating-heart for tricuspid valve surgery under total thoracoscopy has the advantages of minimal surgical trauma and quick postoperative recovery.For patients who meet the indications for the surgery,early surgery may lead to a higher probability of receiving tricuspid valvuloplasty and better perioperative outcomes.