Department of Cardiovascular Surgery, Chinese PLA General Hospital, Beijing, 100853, China.
Chinese PLA General Hospital.
Heart Surg Forum. 2020 Sep 14;23(5):E647-E651. doi: 10.1532/hsf.2931.
Reoperation for isolated tricuspid valve (TV) surgery is considered a high-risk procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either through thoracoscopic approach (thoracoscopic group), right thoracotomy (thoracotomy group), or median sternotomy (sternotomy group).
We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-TV procedure through thoracoscopic approach (n = 33), right lateral thoracotomy approach (n = 14), or sternotomy (n = 72).
All patients successfully underwent elective surgery, with no intraoperative conversion or death occurring. 69% and 31% of patients received valve replacement and valvuloplasty, respectively. After operation, one patient in the sternotomy group received reoperation for bleeding, while another patient received valve replacement surgery 2 weeks after operation due to heart failure caused by valvuloplasty failure. No obvious complications occurred in the minimally invasive groups. The overall success rate of valve repair during 1-year follow-up was 99.2%.
Minimally invasive, isolated TV surgery as reoperation can be safe and may improve clinical outcome.
孤立性三尖瓣(TV)手术的再次手术被认为是一种高风险的手术。最佳的手术方法仍存在争议。我们分析了通过胸腔镜(胸腔镜组)、右开胸(开胸组)或正中开胸(胸骨切开组)进行孤立性 TV 再次手术的经验。
我们回顾性分析了所有接受胸腔镜(n = 33)、右侧侧开胸(n = 14)或正中开胸(n = 72)再次 TV 手术的既往心脏手术患者。
所有患者均成功接受了择期手术,无术中转换或死亡发生。分别有 69%和 31%的患者接受了瓣膜置换和瓣成形术。手术后,胸骨切开组有 1 例患者因出血再次接受手术,另 1 例患者因瓣成形术失败导致心力衰竭,在手术后 2 周接受了瓣膜置换手术。微创组无明显并发症发生。1 年随访时,瓣膜修复的总成功率为 99.2%。
作为再次手术的微创孤立性 TV 手术是安全的,可能改善临床结果。