Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, Guangdong, P.R. China.
Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital's Nanhai Hospital, The Second People's Hospital of Nanhai District, Foshan, Guangdong, P.R. China.
Heart Lung Circ. 2020 Dec;29(12):1880-1886. doi: 10.1016/j.hlc.2020.05.100. Epub 2020 Jun 14.
The role of endoscopic surgery in treating late severe tricuspid regurgitation after cardiac surgery has not been well investigated. The aim of this study was to evaluate the outcomes of a combination of a beating-heart, minimally invasive approach and a leaflet-augmentation technique in treating tricuspid regurgitation after cardiac surgery.
This was a retrospective cohort study. From January 2015 to July 2018, patients undergoing reoperative tricuspid valve repair with a totally endoscopic approach were enrolled. Procedures were performed on beating hearts with normothermic cardiopulmonary bypass (CPB).
A total of 43 adults (mean age 53.4±11.4 yr; 9 men) met the inclusion criteria. The interval between prior cardiac surgery and current tricuspid repair was 17.6±6.5 years. Ten (10) patients had previous tricuspid repair and concomitant previous cardiac surgery. In the current endoscopic approach, tricuspid repair techniques included 38 leaflet augmentations, 38 annular ring placements, five artificial chordae, one cleft closure, five commissure recreations, and eight papillary muscle relaxations. Mean CPB time, median ventilation time, and median hospital stay were 128.5±54.2 minutes, 20.5 hours (range, 6-436 hrs), and 7 days (range, 4-56 d), respectively. There were only three in-hospital deaths and no follow-up mortality. The regurgitant jet area was decreased from 21.5±12.1 cm preoperatively to 2.4±2.2 cm postoperatively (p<0.001). In patients with previous tricuspid repair, although the technique of valvuloplasty seems more complex, CPB time, procedure time and hospital stay were not longer than in patients who did not have previous tricuspid repair.
Beating-heart, video-assisted, minimal access tricuspid repair after previous cardiac surgery is feasible, reproducible, and associated with low mortality, even in patients who have had previous tricuspid repair.
内镜手术在治疗心脏手术后晚期重度三尖瓣反流中的作用尚未得到充分研究。本研究旨在评估在心脏手术后治疗三尖瓣反流时，采用心脏不停跳、微创入路和瓣叶增强技术相结合的方法的治疗效果。
这是一项回顾性队列研究。从 2015 年 1 月至 2018 年 7 月，我们招募了接受全内镜方法再次行三尖瓣瓣修复术的患者。手术在常温体外循环（CPB）下进行心脏不停跳。
共有 43 名成年人（平均年龄 53.4±11.4 岁；9 名男性）符合纳入标准。既往心脏手术后与当前三尖瓣修复之间的间隔为 17.6±6.5 年。10 例（10 例）患者有既往三尖瓣修复和同期既往心脏手术。在当前的内镜方法中，三尖瓣修复技术包括 38 个瓣叶增强、38 个瓣环放置、5 个人工腱索、1 个裂孔关闭、5 个连合重建、8 个乳头肌松弛。平均 CPB 时间、中位通气时间和中位住院时间分别为 128.5±54.2 分钟、20.5 小时（范围 6-436 小时）和 7 天（范围 4-56 天）。仅 3 例院内死亡，无随访死亡。反流射流面积从术前的 21.5±12.1cm2 减少到术后的 2.4±2.2cm2（p<0.001）。在有既往三尖瓣修复的患者中，尽管瓣成形术的技术似乎更为复杂，但 CPB 时间、手术时间和住院时间并不长于没有既往三尖瓣修复的患者。
心脏不停跳、视频辅助、微创入路的心脏手术后再次行三尖瓣修复是可行的、可重复的，且死亡率低，即使在有既往三尖瓣修复的患者中也是如此。
