The application of minimally invasive tricuspid valvuloplasty technique with patch augmentation in reoperative cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KE Yingjie ^1,2 , CHEN Zerui ¹ ,  HUANG Huanlei ¹ , ZENG Qingshi ¹ , GUO Huiming ¹ , HUANG Jingsong ¹ , LIU Jing ¹ , LIU Jian ¹ , ZHANG Xiaohua ¹ , LU Cong ¹

1. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510100, P.R.China;
2. The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, P.R.China;

Corresponding author：

HUANG Huanlei, Email: hhuanlei@hotmail.com

Keywords：

Minimally invasive surgery; tricuspidplasty; reoperative cardiac surgery; tricuspid leaflets augmentation

DOI：

10.7507/1007-4848.201803028

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To evaluate the efficacy of a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating severe tricuspid regurgitation (TR) after cardiac surgery. Methods From January 2015 to August 2017, patients undergoing reoperative tricuspid valve repair (TVP) with minimally invasive approach and leaflets augmentation were enrolled. Cardiopulmonary bypass (CPB) was established via femoral vessels and the procedures were performed on beating heart with normothermic CPB. A bovine pericardial patch was sutured to leaflets to augment the native anterior and posterior leaflets. Other repair techniques, such as ring implantation and leaflet mobilization, were also applied as needed. Results A total of 28 patients (mean age 55.6±10.1 years, 5 males, 23 females) were enrolled. One patient was converted to median sternotomy due to pleural cavity adhesion. Twenty-seven patients underwent totally endoscopic TVP with leaflets augmentation. No patients was transferred to tricuspid valve replacement. Two patients died in hospital. All patients were followed up for 7.4±5.0 months and there was no late death and reoperation. Regurgitation area was converted from 20.7±10.1 cm² to 3.3±3.3 cm² after TVP according to the latest echocardiography (P<0.001). Conclusion Minimally TVP with leaflets augmentation is effective in treating severe isolated TR after primary cardiac surgery. It can significantly increase success rate of tricuspid valvuloplasty and decrease the surgical trauma.

Citation： KE Yingjie, CHEN Zerui, HUANG Huanlei, ZENG Qingshi, GUO Huiming, HUANG Jingsong, LIU Jing, LIU Jian, ZHANG Xiaohua, LU Cong. The application of minimally invasive tricuspid valvuloplasty technique with patch augmentation in reoperative cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(7): 577-582. doi: 10.7507/1007-4848.201803028 Copy

1.	Goldman ME, Guarino T, Fuster V, et al. The necessity for tricuspid valve repair can be determined intraoperatively by two-dimensional echocardiography. J Thorac Cardiovasc Surg, 1987, 94(4): 542-550.
2.	Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
3.	Hannoush H, Fawzy ME, Stefadouros M, et al. Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis. Am Heart J, 2004, 148(5): 865-870.
4.	Kwak JJ, Kim YJ, Kim MK, et al. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4): 732-737.
5.	Pagnesi M, Montalto C, Mangieri A, et al. Tricuspid annuloplasty versus a conservative approach in patients with functional tricuspid regurgitation undergoing left-sided heart valve surgery: A study-level meta-analysis. Int J Cardiol, 2017, 240: 138-144.
6.	Cho IJ, Moon J, Shim CY, et al. Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement. Am J Cardiol, 2011, 107(2): 280-284.
7.	Chang BC, Lim SH, Yi G, et al. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg, 2006, 81(4): 1317-1323.
8.	Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
9.	Jeong DS, Park PW, Mwambu TP, et al. Tricuspid reoperation after left-sided rheumatic valve operations. Ann Thorac Surg, 2013, 95(6): 2007-2013.
10.	Casselman FP, Van Slycke S, Wellens F, et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation, 2003, 108(Suppl 1):II48-54.
11.	Pfannmüller B, Davierwala P, Misfeld M, et al. Postoperative outcome of isolated tricuspid valve operation using arrested-heart or beating-heart technique. Ann Thorac Surg, 2012, 94(4): 1218-1222.
12.	Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr, 2013, 26:921-64.
13.	Grossi EA, Galloway AC, Ribakove GH, et al. Impact of minimally invasive valvular heart surgery: a case-control study. Ann Thorac Surg, 2001, 71(3): 807-810.
14.	Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
15.	Bolotin G, Kypson AP, Reade CC, et al. Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? J Heart Valve Dis, 2004, 13(2): 155-158.
16.	Pettinari M, Bertrand P, Van Kerrebroeck C, et al. Mid-term results of leaflet augmentation in severe tricuspid functional tethering. Eur J Cardiothorac Surg, 2016, 50(3): 504-508.
17.	McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
18.	Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
19.	Quarti A, Iezzi F, Soura E, et al. Anterior and posterior leaflets augmentation to treat tricuspid valve regurgitation. J Card Surg, 2015, 30(5): 421-423.
20.	Choi JB, Kim NY, Kim KH, et al. Tricuspid leaflet augmentation to eliminate residual regurgitation in severe functional tricuspid regurgitation. Ann Thorac Surg, 2011, 92(6): e131-e133.

1. Goldman ME, Guarino T, Fuster V, et al. The necessity for tricuspid valve repair can be determined intraoperatively by two-dimensional echocardiography. J Thorac Cardiovasc Surg, 1987, 94(4): 542-550.
2. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis, 1999, 8(1): 57-62.
3. Hannoush H, Fawzy ME, Stefadouros M, et al. Regression of significant tricuspid regurgitation after mitral balloon valvotomy for severe mitral stenosis. Am Heart J, 2004, 148(5): 865-870.
4. Kwak JJ, Kim YJ, Kim MK, et al. Development of tricuspid regurgitation late after left-sided valve surgery: a single-center experience with long-term echocardiographic examinations. Am Heart J, 2008, 155(4): 732-737.
5. Pagnesi M, Montalto C, Mangieri A, et al. Tricuspid annuloplasty versus a conservative approach in patients with functional tricuspid regurgitation undergoing left-sided heart valve surgery: A study-level meta-analysis. Int J Cardiol, 2017, 240: 138-144.
6. Cho IJ, Moon J, Shim CY, et al. Different clinical outcome of paravalvular leakage after aortic or mitral valve replacement. Am J Cardiol, 2011, 107(2): 280-284.
7. Chang BC, Lim SH, Yi G, et al. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg, 2006, 81(4): 1317-1323.
8. Shiran A, Sagie A. Tricuspid regurgitation in mitral valve disease incidence, prognostic implications, mechanism, and management. J Am Coll Cardiol, 2009, 53(5): 401-408.
9. Jeong DS, Park PW, Mwambu TP, et al. Tricuspid reoperation after left-sided rheumatic valve operations. Ann Thorac Surg, 2013, 95(6): 2007-2013.
10. Casselman FP, Van Slycke S, Wellens F, et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation, 2003, 108(Suppl 1):II48-54.
11. Pfannmüller B, Davierwala P, Misfeld M, et al. Postoperative outcome of isolated tricuspid valve operation using arrested-heart or beating-heart technique. Ann Thorac Surg, 2012, 94(4): 1218-1222.
12. Hahn RT, Abraham T, Adams MS, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr, 2013, 26:921-64.
13. Grossi EA, Galloway AC, Ribakove GH, et al. Impact of minimally invasive valvular heart surgery: a case-control study. Ann Thorac Surg, 2001, 71(3): 807-810.
14. Casselman FP, La Meir M, Jeanmart H, et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation, 2007, 116(11 Suppl): I270-I275.
15. Bolotin G, Kypson AP, Reade CC, et al. Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? J Heart Valve Dis, 2004, 13(2): 155-158.
16. Pettinari M, Bertrand P, Van Kerrebroeck C, et al. Mid-term results of leaflet augmentation in severe tricuspid functional tethering. Eur J Cardiothorac Surg, 2016, 50(3): 504-508.
17. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
18. Dreyfus GD, Raja SG, John Chan KM. Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation. Eur J Cardiothorac Surg, 2008, 34(4): 908-910.
19. Quarti A, Iezzi F, Soura E, et al. Anterior and posterior leaflets augmentation to treat tricuspid valve regurgitation. J Card Surg, 2015, 30(5): 421-423.
20. Choi JB, Kim NY, Kim KH, et al. Tricuspid leaflet augmentation to eliminate residual regurgitation in severe functional tricuspid regurgitation. Ann Thorac Surg, 2011, 92(6): e131-e133.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

The application of minimally invasive tricuspid valvuloplasty technique with patch augmentation in reoperative cardiac surgery

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content