Xiao Shuo, Wang Qiuji, Fang Dou, Wang Zhenzhong, Ke Yingjie, Zhang Zhaolong, Li Yuxin, Zhong Lishan, Huang Huanlei
Medical school, South China University of Technology, 510006 Guangzhou, Guangdong, China.
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, 510080 Guangzhou, Guangdong, China.
Rev Cardiovasc Med. 2024 May 23;25(5):188. doi: 10.31083/j.rcm2505188. eCollection 2024 May.
Leaflet augmentation is often required to correct an inadequate leaflet size due to leaflet thickening, contracture and junctional fusion in patients with tricuspid valve regurgitation (TR) after left-side valve surgery (LSVS). However, the ideal material for leaflet augmentation remains controversial. This article aims to compare the medium- and long-term results of tricuspid valve repair with bovine pericardium (BP) and expanded Polytetrafluoroethylene (ePTFE) patches for the augmentation of tricuspid leaflets and to compare the durability of the two materials.
From January 2015 to April 2023, a total of 69 patients with severe isolated TR underwent tricuspid valvuloplasty (TVP) by leaflets augmentation with patches in our institute. According to the different types of patches, they were divided into the BP group (n = 44) and the ePTFE group (n = 25).
There were 3 perioperative deaths (4.3%), one case was due to low cardiac output syndrome in the BP group, and 2 cases were due to acute respiratory dysfunction syndrome and low cardiac output syndrome in the ePTFE group, respectively. Before discharge, the area of the TR jet on echocardiography decreased from 23.5 9.1 to 4.2 3.4 . One case in each group was found to have increased blood flow velocity at the tricuspid orifice. After discharge, one patient in each group underwent repeat TVP, in the BP group because of shortened chordae and in the ePTFE group because of calcification of the patch. During the entire follow-up period, there were 7 cases of severe TR (10.1%), 5 in the BP group and 2 in the ePTFE group, a total of 5 cases of tricuspid stenosis (7.2%), 4 in the BP group and 1 in the ePTFE group, and a total of 6 deaths (8.7%), 5 in the BP group and 1 in the ePTFE group. Transthoracic ultrasound in a patient with tricuspid stenosis suggests stiff leaflet movement and poor motion.
Leaflet patch enlargement can be safely used in tricuspid valve repair, but BP patches carry a risk of reduced flexibility and stiffness of movement, and ePTFE patches carries a risk of calcification.
在左侧瓣膜手术（LSVS）后患有三尖瓣反流（TR）的患者中，由于瓣叶增厚、挛缩和交界融合，通常需要进行瓣叶扩大术来纠正瓣叶尺寸不足。然而，用于瓣叶扩大的理想材料仍存在争议。本文旨在比较使用牛心包（BP）和膨体聚四氟乙烯（ePTFE）补片进行三尖瓣修复以扩大三尖瓣瓣叶的中长期结果，并比较这两种材料的耐久性。
2015年1月至2023年4月，我院共有69例重度单纯性TR患者接受了使用补片进行瓣叶扩大的三尖瓣成形术（TVP）。根据补片类型不同，将他们分为BP组（n = 44）和ePTFE组（n = 25）。
围手术期死亡3例（4.3%），BP组1例死于低心排血量综合征，ePTFE组2例分别死于急性呼吸功能障碍综合征和低心排血量综合征。出院前，超声心动图显示TR反流束面积从23.5±9.1降至4.2±3.4。每组各有1例发现三尖瓣口血流速度增加。出院后，每组各有1例患者接受了再次TVP，BP组是因为腱索缩短，ePTFE组是因为补片钙化。在整个随访期间，共有7例重度TR（10.1%），BP组5例，ePTFE组2例；共有5例三尖瓣狭窄（7.2%），BP组4例，ePTFE组1例；共有6例死亡（8.7%），BP组5例，ePTFE组1例。三尖瓣狭窄患者的经胸超声显示瓣叶运动僵硬且活动不佳。
瓣叶补片扩大术可安全用于三尖瓣修复，但BP补片存在瓣叶运动灵活性和僵硬度降低的风险，ePTFE补片存在钙化风险。
