A clinical study on the safety and effectiveness of concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement in beating heart

WEI Kequan; LI Sicong; JIANG Wei; HUANG Lijian; QIN Jian; HUANG Zhenwang; LONG Xiaomao

doi:10.3969/j.issn.1674-3806.2024.03.05

Abstract：Objective To compare the surgical outcomes and short-term therapeutic effects between concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement and concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement.Methods The clinical data of 94 patients with functional tricuspid regurgi-tation(TR)who received concomitant tricuspid annuloplasty during mitral valve replacement in the People's Hospital of Guangxi Zhuang Autonomous Region from January 2014 to December 2021 were retrospectively analyzed.Among the 94 patients,68 patients received concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement in beating heart(the median sternotomy group),while 26 patients received concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement in beating heart(the total thoracoscopic group).Propensity score matching(PSM)was used to reduce selection bias,and 26 pairs of cases were obtained finally for analysis.The basic information,surgical treatment data and postoperative follow-up data were compared between the two groups,including the results of cardiac color ultrasound and the indicators related to hospitalization due to surgery.Results The operation time,cardiopulmonary bypass time and aortic cross-clamp time in the total thoracoscopic group was longer than that in the median sternotomy group,and the difference was statistically significant(P＜0.05).The results of cardiac color ultrasound examination1 month after surgery showed that there were no significant differences in mitral systolic blood flow velocity,mitral valve pressure difference,pressure halving time(PHT),area of TR,right atrial diameter(RAD),right ventricular diameter(RVD)and the incidence of atrial fibrillation between the two groups(P＞0.05).There was no significant difference in TR recur-rence rate 24 months after operation between the two groups(P＞0.05).The results of cardiac color ultrasound examination showed that the mitral valve pressure difference in the median sternotomy group was significantly lower than that in the total thoracoscopic group(P＜0.05),but there were no significant differences in mitral systolic blood flow velocity,PHT,area of TR,RAD,RVD,left ventricular ejection fraction(LVEF),and the incidence rates of perivalvular leakage,atrial fibrillation and pulmonary arterial hypertension between the two groups 24 months after operation(P＞0.05).Conclusion The effectiveness of concomitant tricuspid annuloplasty during total thoracoscopic mitral valve replacement is equivalent to that of concomitant tricuspid annuloplasty during median sternotomy mitral valve replacement.These two surgical methods can be used for clinical treatment of mitral and tricuspid combined valvular lesions.