Objective To summarize the clinical characteristics and management experiences of patients with severe tricuspid regurgitation (TR) after mitral valve surgery. Methods Thirty patients were followed up and reviewed for this report. There were 1 male and 29 female patients whose ages ranged from 32 to 65 years (47.1±92 years). A total of 28 patients had atrial fibrillation and 2 patients were in sinus rhythm. There were 13 patients of mild TR, 10 patients of moderate TR and 7 patients of severe TR at the first mitral valve surgery. Five patients received the tricuspid annuloplasty of De Vega procedure at the same time, 2 patients received Kay procedure. The predominant presentation of patients included: abdominal discomfort (93.3%, 28/30), edema (66.7%,20/30), palpitation (56.7%, 17/30), and ascites (20%, 6/30). Results Nine patients underwent the secondary surgery for severe TR. The secondary surgery included tricuspid valve replacement (6 cases), mitral and tricuspid valve replacement (2 cases) and Kay procedure (1 case). Eight patients were recovered and discharged and 1 patient died from the bleeding of right atrial incision and low output syndrome. Twentyone patients received medical management and were followed up. One case was lost during followup. Conclusion Surgery or medical management should be based on the clinical characteristics of patients with severe TR after mitral valve surgery. It should be based on the features of tricuspid valve and the clinical experience of surgeon to perform tricuspid annuloplasty or replacement.
Objective To improve surgical results, the experience of surgical management of Ebstein anomaly in 36 cases is reported and reviewed. Methods Surgical procedures included tricuspid valve replacement (6 cases), Danielson’s operation (28 cases), Carpentier’s operation (2 cases), among them, there were 5 cases of ablation of right atrioventricular accessory pathway. Results Four patients died early after operation in the hospital, 3 from right heart failure (1 case of tricuspid valve replacement and 2 cas...
Abstract： Ebstein anomaly is a relatively rare congenital heart malformation which can affect heart function significantly. It may cause right heart failure, even whole heart failure and eventually death. In recent years, the surgery has made much progress in dealing with the abnormal valve, improving the right ventricle function and pretreatment of its related complications. However, because of its complexity and diversity in pathological anatomy and clinical manifestations, the disease has not got an “almighty standard” to treat all pathological anatomy types of the deformity, or asurgery strategy to solve the practical problems encountered in all clinic situations. Furthermore, the therapeutic effect is also unsatisfactory. This article will review the advance of treatment of Ebstein anomaly and prevention of its related complications.
Objective To explore the evolving strategies and compare perioperative and long-term outcomes of tricuspid valve replacement (TVR) in recent 20 years in our hospital.MethodsBetween 1998 and 2018, the clinical data of 608 patients who underwent TVR at the Department of Cardiac Surgery, Guangdong Provincial People’s Hospital were retrospectively analyzed. There were 201 males and 407 females, with a median age of 47.0 (36.0, 57.0) years. Patients were divided into a biological tricuspid valve (BTV, n=427) group and a mechanical tricuspid valve (MTV, n=181) group. Propensity score matching was used to balance the baseline difference. Surgical strategy evolving, postoperative and long-term outcomes were analyzed between the two groups.ResultsSince 2008, the usage ratio of biological valves was significantly higher than that of mechanical valves. Seventy-nine (13.0%) patients died in hospital after TVR. Before propensity score matching, the postoperative mortality of the BTV group was higher than that of the MTV group (15.2% vs. 7.7%, P=0.012), and there was no statistical difference between the two groups after matching (10.4% vs. 7.2%, P=0.372). The duration of postoperative ventilator support in the BTV group was longer than that in the MTV group [22.0 (15.0, 37.0) h vs. 19.0 (11.0, 27.0) h, P=0.003], and the incidence of postoperative dialysis and re-thoracotomy exploring for bleeding was higher in the BTV group (8.9 % vs. 2.8%, 9.4% vs. 6.6%, respectively). However, there was no statistical difference in mortality after matching. The median follow-up time of discharged patients was 101.0 (65.0, 147.0) months, ranged from 1 to 265 months, and the follow-up rate was 82.2%. During the follow-up period, there were 101 deaths (19.1%) of whom 68 were from the BTV group and 33 from the MTV group. The survival rates at 1 year, 5 years, 10 years, 15 years and 20 years of all patients were 85.0% (95%CI 82.2-87.9), 78.9% (95%CI 75.7-82.4), 71.1% (95%CI 67.3-75.3), 59.7% (95%CI 54.2-65.6) and 51.7% (95%CI 43.3-60.7), and there was no statistical difference between the two groups after matching (P=0.46). The median time of tricuspid valve failure was 84.0 (54.0-111.0) months.ConclusionTVR is associated with high perioperative risks. There is no statistical difference in early mortality and long-term survival between biological and mechanical valve, while patients with mechanical valve has higher risk of re-operation for valve failure. Therefore, the type of prosthetic valve can be selected according to the patients' age, physical condition and the doctors’ experience.
ObjectiveTo compare the outcomes of mechanical prosthetic versus bioprosthetic replacement of tricuspid valve. Methods We retrospectively analyzed the clinical data of 344 patients underwent tricuspid valve replacement (TVR) in Guangdong General Hospital between January 2000 and December 2010. There were 227 female and 117 male patients with their age of 8-74 (42.0±13.3) years. We allocated the patients into two groups: 168 patients (48.8%) at age of 37.0±11.6 years underwent mechanical tricuspid valve replacement (the MTVR group) and 176 (51.2%) patients at age of 46.0±13.4 years underwent biological tricuspid valve replacement (the BTVR group). Follow-up data were obtained via patients' visiting the outpatient clinic, telephone or mail contacts. ResultsThe mean follow-up time was 5.7 years (ranged from 2 months to 12.6 years). In the BTVR group, 149 patients survived to discharge from hospital, and 144 patients were followed-up successfully, giving a 96.6% follow-up rate. Early mortality (within 30 days post-operation) occurred in 29 patients (16.5%), and 14 patients (7.9%) died after 30 days post-operation. Eighteen bioprosthetic valve degeneration was found during follow-up, and infective endocarditis in 3 patients. In the MTVR group, 152 patients survived to discharge from hospital, 142 patients (93.4%) were followed-up. Early mortality in 13 patients (7.7%), and 14 patients (8.3%) died after 30 days post-operation. Nineteen patients suffered from mechanical prosthesis obstruction, no infective endocarditis patients was found in the MTVR group. There was no statistical difference between the BTVR group and the MTVR group in mortality rate (24.4% versus 16.1%, P=0.054) and in reoperation rate (4.2% versus 9.9%, P=0.051), respectively．There were statistical differences in long-term survival rates between the BTVR group and the MTVR group with 1 year survival rate(78% vs. 89%), 5 years survival rate(74% vs. 86%), and 10 years survival rate (66% versus 78%) with P value at 0.003. ConclusionsThis study suggests that the type of implanted prosthesis in tricuspid replacement does not affect long-term outcomes or the reoperation rate. The survival rate is higher in the MTVR group than that in the BTVR group, which may contribute to younger age in the MTVR group. There is a tendency in higher infective endocarditis incidence in the BTVR group than that in the MTVR group.
Functional tricuspid valve regurgitation (TR) is often secondary to left-sided valvular heart diseases. The precise diagnosis of TR degree and reasonable treatment can improve the long-term prognosis of patient. Now we believe that rectifying the TR during left cardiac valve surgery can prevent a further development of TR and avoid the reducing of the cardiac function for patients with moderate TR, tricuspid valve annulus diameter>40 mm in late diastole, tricuspid valve diameter/body surface area>21 mm/m2, and intraoperative tricuspid valve diameter >70 mm, especially for patients with atrial fibrillation and atrial enlargement. The use of prosthetic ring can effectively prevent recurrence of TR in long term and we should try to use hard or semihard "C" shape prosthetic ring as much as possible. The tricuspid valve replacement should be avioded because of its higher mortality.
Objective To analyze the medium-and long-term r esults of tricuspid valve replacement(TVR), to summarize the experience in opera tive therapy for tricuspid valve disease. Methods From January 1998 to May 2006, sixty seven patients had undergone TVR. The etiology was rheumatic disease in 25 cases, congenital disease in 37 cases, degenerative disease in 1 case, infective endocarditis in 3 cases, a nd cardiac tumor in 1 case. All operations were performed under general anesthes i a and by cardiopulmonary bypass. Bioprostheses was replaced in 28 patients, whil e mechanical valve was replaced in 39 patients. Associated procedure included mi tral valve replacement in 13 cases, mitral valve replacement and aortic valve replac ement in 12 cases, repair of ventricular septal defect in 1 case, repair of atri al septal defect in 1 case, and radioablation of atrial fibrillation in 3 case s. Results The operative mortality was 11.94% (8/67)，among these patients , 6 cases died of serious heart failure,1 case died of ventricular fibrillation, 1 case died of multi organ failure. During follow-up, 1 patient died of biopro thesis dysfunction 1 year after the operation, 1 patient died of cerebral emboli s m 6 years after the operation. Through statistical analysis, it showed that the mortality of TVR in rheumatic tricuspid valve disease was higher than that in co ngenital tricuspid valve disease ［5.56%（2/36）vs. 24.00% (6/25); χ2=4.425 , P=0.036］; the mortality in second time operation was higher than that in first time operation ［30.00%（3/10）vs. 8.77% (5/57);χ2=3.646，P=0.033 ］; while there was no significant difference in immediate and long-term result s with different choice of bioprosthetic or mechanical valve in TVR (χ2=0.002 , P=0.961). Conclusion Operative an d follow-up mortality is high in the TVR, valve replac ement is the last selection for the treatment of serious tricuspid disease, appr opriate operative technique and perioperative therapy is the key for success o f the operation.
Objective We sought to review our experience of cone reconstruction for tricuspid valve repair and to evaluate this therapeutic approach for patients with Ebstein's anomaly, to report early clinical outcomes. Method We retrospectively analyzed the clinical data of 19 consecutive patients underwent cone reconstruction technique in our hospital between December 2011 and June 2014 year. There were 8 males and 11 females at mean age 24 years(ranged from 3 months to 53 years). Six patients were diagnosed by electrocardiography or electrophysiology examination, including 4 patients with B type Wolff-Parkinson-White syndrome and atrial fibrillation, 2 patients with paroxysmal supraventricular tachycardia. Results There was one patient of severe cyanosis hospital death for low cardiac output syndrome depending on cardiopulmonary bypass. The remaining patients were recovered smoothly. Atrial fibrillation associated with frequent ventricular premature, restoration of sinus rhythm with lidocaine and amiodarone occurred in one patient. Early postoperative echocardiograms showed good ventricular morphology and reduction in tricuspid regurgitation (TR) grade. Eleven patients were with mild regurgitation and 7 patients without or with trace amounts of regurgitation. All patients were followed up for 5-30 months. And postoperative cardiac function recovered to gradeⅠin 10 patients and gradeⅡ in 8 patients. None of patients needed re-operation. Conclusions The cone reconstruction technique shows low in-hospital mortality and complication rate, reducing TR, restoring right ventricular function, allowing reverse remodeling of the heart. Early postoperative follow-up shows improvement in patients' clinical outcome and low incidence of re-operation.
Recently, several transcatheter devices for aortic valve replacement and mitral valve repair have been used in clinic, and researchers have designed a variety of tricuspid valve (TV) intervention devices. We reviewed the current status of transcatheter TV intervention, and focused on the structures of these devices and the early results of clinical trials. Undoubtedly, transcatheter intervention for TV is promising, innovational and safe for patients with severe TV regurgitation.
ObjectiveTo analyze risk factors and long-term outcomes of surgical treatment for isolated tricuspid regurgitation (TR) after left-sided valve replacement. MethodsWe retrospectively analyzed clinical data of 65 patients who underwent surgical treatment for severe isolated TR after left-sided valve replacement in Guangdong Cardiovascular Institute from January 2000 to June 2013. There were 12 male and 53 female patients with their age of 37-72 (52.3±8.0) years. Fifty-nine patients had atrial fibrillation (AF). There were 61 patients with functional TR and 4 patients with rheumatic TR. Six patients were in New York Heart Association (NYHA) functional class Ⅱ,40 patients were in NYHA class Ⅲ,and 19 patients were in NYHA class Ⅳ.The duration between the first and second cardiac operation was 1-26 (11.2±4.7) years. Fifty-five patients received tricuspid valve replacement (TVR) and 10 patients received tricuspid valvuloplasty (TVP). ResultsEleven patients (16.9%) died postoperatively. Univariate analysis showed that male gender,right ventricular internal dimension,preoperative serum albumin level (ALB) direct bilirubin (DBil) level,cardiopulmonary bypass (CPB) time and preoperative NYHA functional class Ⅳ were significantly correlated with postoperative death. Preoperative cardiothoracic ratio(C/T) TR area,left ventricular ejection fraction (LVEF) pulmonary arterial systolic pressure (PAs) preoperative hemoglobin(HGB) level,creatinine (Cr) level,total bilirubin (TBil) level,alanine aminotransferase (ALT) level and the duration between the first and second cardiac operation were not significantly related with surgical mortality. Multivariate logistic regression analysis showed that preoperative NYHA functional class Ⅳ was an independent risk factor of in-hospital death (OR=7.23,95% CI:1.57-33.25,P=0.01). Among the 54 survivors,50 patients (92.6%) were followed up for 1-160(47.2±43.3) months. Five patients died during follow-up including 3 TVR patients with heart failure,1 TVR patient with aortic valve obstruction and 1 TVP patient with sudden cardiac arrest. One-year and 5-year survival rates of TVR patients were 95%±3% and 89%±7% respectively,and 1-year and 5-year survival rates of TVP patients were 100% and 80%±18% respectively(P=0.92). Cox regression analysis showed that preoperative Cr level was an independent risk factor of long-term mortality (HR=1.10,95% CI:1.03-1.17,P<0.01). ConclusionIn-hospital mortality of patients with isolated TR after left-sided valve replacement who undergo surgical treatment is significantly related with preoperative overall condition and heart function. Surgical therapy should be performed before severe heart failure occurs. Postoperative 5-year survival rate is good,and long-term mortality is related with preoperative Cr level.