›› 2017, Vol. 37 ›› Issue (7): 987-.doi: 10.3969/j.issn.1674-8115.2017.07.018

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Clinical analysis on tricuspid valve replacement for secondary tricuspid regurgitation late after left-sided valve surgery#br#

LI Wei , GU Wei-li, ZHANG Wei, FANG Liang   

  1. Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai  200030, China
  • Online:2017-07-28 Published:2017-08-25
  • Supported by:
     Scientific and Technical Project of Shanghai Chest Hospital, YZ14-01

Abstract:  Objective · To analyse the outcomes of tricuspid valve replacement (TVR) for secondary tricuspid regurgitation (STR) late after left-sided valve surgery during perioperative period and mid-term follow-up, investigate mechanisms of STR and surgical risk factors.  Methods · A total of 85 consecutive patients who underwent the TVR surgery were analyzed. The perioperative and mid-term clinical outcomes were retrospectively investigated. The data were divided into bioprosthesis group (n=50) and mechanical prosthesis group (n=35) according to the prosthesis used, and divided into right anterolateral thoracotomy(RALT) group (n=51) and sternotomy(S) group (n=34) according to the surgical incision.  Results · In-hospital mortality was 8.2% (7/85). There was no significant difference in the mortality with different choice of bioprosthetic or mechanical valve (4/50 vs 3/35, χ2=0.009,P=1.000); while there was significant difference between S group and RALT group (6/34 vs 1/51,χ2=6.642, P=0.015). Seven cases all died of right heart failure and severe low cardiac output syndrome. Five (5.9%) cases died in perioperative within 30 in-hospital days and 2 (2.4%) cases died after 30 in-hospital days. Seventy-four cases were followed up. With the follow-up of (31.5±23.1) months, there were 4 case of late deaths(5.4%), all of whom were mechanical prosthesis, of whom 3 died in cardiac related death and 1 died in later period bowel cancer. Seventy cases survived in New York Heart Association (NYHA) class I-II with no coagulated accident and redo-TVR.  Conclusion · The perioperative and mid-term clinical outcomes are satisfied in timely and reasonable TVR with the standard follow-up for STR late after left-sided valve surgery. Right anterolateral incision is recommend for isolated TVR.

Key words:  left-sided valve surgery, valvular heart disease, tricuspid valve replacement, bioprosthetic valve, mechanical valve