Lu Shuyang, Song Kai, Yao Wangchao, Xia Limin, Dong Lili, Sun Yongxin, Hong Tao, Yang Shouguo, Wang Chunsheng
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China.
Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China.
J Cardiothorac Surg. 2020 Jun 18;15(1):146. doi: 10.1186/s13019-020-01192-1.
Redo isolated tricuspid valve surgery is associated with a high morbidity and mortality, and its optimal timing remains controversial. Hence, here we reviewed the early and midterm results of simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery in patients at high risk.
A total of 32 consecutive patients underwent a redo isolated tricuspid valve surgery using minimally invasive, beating-heart technique through a right lateral thoracotomy in our center between June 2016 and April 2020. The mean age of patients was 57.4 ± 8.3 years, and 18 patients (56.3%) were women. The mean preoperative EuroSCORE was 7.8 ± 1.4 (range: 6-11). Follow-up was 87.1% complete, with a mean duration of 26.3 ± 12.3 months.
Both in-hospital and 30-day mortalities were 3.1%. Tricuspid valve replacement with bioprosthesis was performed in 30 patients (93.8%), and the remaining two patients (6.2%) underwent tricuspid repair (annuloplasty and leaflet reconstruction). The mean cardiopulmonary bypass time was 81.5 ± 29.0 min. The overall in-hospital duration and intensive care unit (ICU) times were 13.6 ± 7.6 days and 4.1 ± 2.8 days, respectively. Postoperative complications included prolonged ventilation in six patients (18.8%), acute kidney injury in three patients (9.4%), and neurologic event, wound infection, or permanent third-degree atrioventricular block, in one patient (3.1%) each. A total of 96.9% patients were discharged uneventfully. Four patients were lost to follow-up; there were no midterm deaths in patients who were followed up.
Simplified, minimally invasive, beating-heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.
再次行单纯三尖瓣手术与高发病率和死亡率相关，其最佳时机仍存在争议。因此，我们在此回顾了采用简化、微创、心脏不停跳技术对高危患者行再次单纯三尖瓣手术的早期和中期结果。
2016年6月至2020年4月期间，我们中心共有32例连续患者通过右侧开胸采用微创、心脏不停跳技术接受了再次单纯三尖瓣手术。患者的平均年龄为57.4±8.3岁，18例患者（56.3%）为女性。术前欧洲心脏手术风险评估系统（EuroSCORE）的平均值为7.8±1.4（范围：6 - 11）。随访完成率为87.1%，平均随访时间为26.3±12.3个月。
住院死亡率和30天死亡率均为3.1%。30例患者（93.8%）接受了生物瓣三尖瓣置换术，其余2例患者（6.2%）接受了三尖瓣修复术（瓣环成形术和瓣叶重建）。平均体外循环时间为81.5±29.0分钟。总的住院时间和重症监护病房（ICU）时间分别为13.6±7.6天和4.1±2.8天。术后并发症包括6例患者（18.8%）通气时间延长、3例患者（9.4%）急性肾损伤，以及各1例患者（3.1%）发生神经事件、伤口感染或永久性三度房室传导阻滞。共有96.9%的患者顺利出院。4例患者失访；随访患者中无中期死亡病例。
采用简化、微创、心脏不停跳技术行再次三尖瓣手术是可行且安全的，早期和中期结果良好。
