Liu Jian, Tan Tong, Huang Huanlei, Gu Wenda, Zang Xin, Ma Jianrui, Wu Hongxiang, Liu Haozhong, Zhuang Jian, Chen Jimei, Guo Huiming
Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China.
Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, China.
Front Cardiovasc Med. 2023 Feb 1;10:1033489. doi: 10.3389/fcvm.2023.1033489. eCollection 2023.
Late severe tricuspid regurgitation (TR) after left-side valve surgery (LSVS) is not uncommon. However, the tricuspid valve has been deemed the forgotten valve because the isolated TR is well tolerated with medication, and reoperation has a higher rate of adverse events. With the advancement of minimally invasive techniques, isolated tricuspid valve reoperation (ITVR) totally endoscopy or transcatheter approach brings the tricuspid valve into spotlight. Our aim is to report the safety and efficacy of minimally invasive ITVR using endoscopic and transcatheter approaches.
From October 2020 to October 2021, 21 patients with LSVS history and secondary massive TR underwent minimally invasive ITVR in our institution. Baseline characteristics, surgical outcomes and follow-up results were analyzed, and data between the totally endoscopy approach and the transcatheter approach were compared.
Of the 21 cases, totally endoscopic isolated tricuspid valve surgery (EITVS) accounts for 16 (76.2%) cases, with 14 tricuspid valvuloplasty cases, and 2 tricuspid valve replacement cases; the remaining 5 (23.8%) cases underwent transcatheter tricuspid valve replacement (TTVR). The mean age was (60.0 ± 8.4) years, with 15 (71.4%) being female. Minimally invasive ITVR procedures were 100% successfully performed in all patients without any perioperative mortality, sternotomy conversion, or reoperation. During the median follow-up of 16.8 months (IQR, 13.0-20.6 months), New York Heart Association Class improved significantly from baseline ( = 0.004). TR severity was significantly improved during postoperative and follow-up period (both < 0.001). Compared with the EITVS group, the TTVR group had a higher clinical risk score [8.00 (8.00, 9.00) vs. 5.00 (3.25, 5.00), = 0.001], but a higher success rate in reducing TR to less than grade 1+ (100 vs. 43.8%, = 0.045) at follow-up.
In our series, minimally invasive ITVR, including EITVS and TTVR, is a safe and feasible option for severe TR after LSVS, and presents excellent early outcomes in selected patients. TTVR is a reliable alternative for patients with high surgical risk. To improve the results of ITVR, it is necessary to improve patient's preoperative status or perform reoperation before the onset of significant right heart failure. Further studies with a larger sample size and a longer follow-up period are awaited.
左侧瓣膜手术（LSVS）后晚期严重三尖瓣反流（TR）并不少见。然而，三尖瓣一直被视为被遗忘的瓣膜，因为单纯TR通过药物治疗耐受性良好，再次手术不良事件发生率较高。随着微创技术的进步，单纯三尖瓣再次手术（ITVR），即完全内镜或经导管方法，使三尖瓣受到关注。我们的目的是报告使用内镜和经导管方法进行微创ITVR的安全性和有效性。
2020年10月至2021年10月，21例有LSVS病史且继发大量TR的患者在我院接受了微创ITVR。分析了基线特征、手术结果和随访结果，并比较了完全内镜方法和经导管方法之间的数据。
21例中，完全内镜下单纯三尖瓣手术（EITVS）占16例（76.2%），其中三尖瓣成形术14例，三尖瓣置换术2例；其余5例（23.8%）接受经导管三尖瓣置换术（TTVR）。平均年龄为（60.0±8.4）岁，女性15例（71.4%）。所有患者微创ITVR手术均100%成功完成，无围手术期死亡、胸骨切开术转换或再次手术。在中位随访16.8个月（IQR，13.0 - 20.6个月）期间，纽约心脏协会心功能分级较基线显著改善（P = 0.004）。术后及随访期间TR严重程度均显著改善（均P < 0.001）。与EITVS组相比，TTVR组临床风险评分更高[8.00（8.00，9.00）对5.00（3.25，5.00），P = 0.001]，但随访时将TR降至1+级以下的成功率更高（100%对43.8%，P = 0.045）。
在我们的系列研究中，包括EITVS和TTVR在内的微创ITVR是LSVS后严重TR的一种安全可行的选择，在选定患者中呈现出良好的早期结果。TTVR是手术风险高的患者的可靠替代方案。为改善ITVR的结果，有必要改善患者术前状态或在严重右心衰竭发作前进行再次手术。有待进行更大样本量和更长随访期的进一步研究。
