Objective To evaluate the preliminary effect of tricuspid annuloplasty for patients with dilated tricuspidannulus and left-sided heart valve surgery by employing combined bicuspidization and modified Kay annuloplasty. Methods?Combined bicuspidization and modified Kay annuloplasty were performed in 158 patients with dilated tricuspidannulus （tricuspid annulus diameter/body surface area≥21 mm/m2） and left-sided heart valve surgery in West China Hospital
between January 2010 and May 2011. There were 27 male and 131 female patients whose age ranged from 17 to 74 （45.9±10.4） years. A total of 92 patients had atrial fibrillation and 66 patients were in sinus rhythm. The severity of tricuspid regurgitation（TR）was graded 0 through 5 as determined by echocardiography.?Results?All the patients recovered from surgery and were discharged from hospital. The average cardiopulmonary bypass time was 100.8±30.5 （range, 54 to 273） min, and the average aortic cross clamping time was 64.5±22.0（range, 25 to 162）min. The average lowest esophageal temperature during aortic cross clamping was 28.5±1.1（range, 26.3 to 34.1）?℃. The average postoperative follow-up was 11.0±5.0 （range, 3 to 19） months. The postoperative TR severity was significantly lower than preoperative TR severity （2.2±1.3 versus 0.4±0.8， P＜0.05）. The postoperative right atrium diameter, right ventricle diameter and left atrium diameter were significantly lower than preoperative measurements （56.5±11.1 mm versus 47.5±8.9 mm， P＜0.05；22.4±4.4 mm versus 20.1±3.3 mm， P＜0.05；62.8±20.1 mm versus 51.9±14.1 mm， P＜0.05）. During follow-up, 5 patients had moderate or severe TR （3.2%， 5/158, moderate in 4 patients, moderate to severe in 1 patient）. There was no significant difference between preoperative and postoperative left ventricle ejection fraction （60.4%±7.9% vervsus 59.6%±8.2%， P＞0.05）.?Conclusion?It is reasonable to perform tricuspid annuloplasty for patients with dilated tricuspid annulus and left-sided heart valve surgery according to their index of tricuspid annulus diameter/body surface area （≥21 mm/m2）. To prevent postoperative residue or progression of TR in patients with dilated tricuspid annulus,it is effective to employ combined bicuspidization and modified Kay annuloplasty.
Citation：
XIAO Xijun,JIANG Lu,LI Yongbo,TANG Hong,ZHOU Wenxia,ZHU Wei.. Preliminary Effect of Tricuspid Annuloplasty for Patients with Dilated Tricuspid Annulus and Left-sided Heart Valve Surgery by Employing Combined Bicuspidization and Modified Kay Annuloplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 516-519. doi:
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Copyright © the editorial department of Chinese Journal of Clinical Thoracic and Cardiovascular Surgery of West China Medical Publisher. All rights reserved
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Surg， 2010， 22（1）：84-89.
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Bernal JM， Gutiérrez-Morlote J， Llorca J， et al. Tricuspid valverepair：an old disease， a modern experience. Ann Thorac Surg， 2004， 78（6）：2069-2075.
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Colombo T， Russo C， Ciliberto GR， et al. Tricuspid regurgitation secondary to mitral valve disease：tricuspid annulus function as guide to tricuspid valve repair. Cardiovas Surg， 2001， 9（4）：367-377.
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Naqshloand MS， Abid AR， Akhtar RP et al. Functional tricuspid regurgitation in rheumatic heart disease：surgical options. Ann Thorac Cardicovasc Surg， 2010， 16（6）：417-425.
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Rogers JH， Bolling SF. Valve repair for functional tricuspid valve regurgitation：anatomical and surgical considerations. Semin Thoracic.
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肖锡俊， 袁宏声， 唐红， 等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重.中国胸心血管外科临床杂志， 2006， 13（5）：307-310.
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肖锡俊， 袁宏声， 黄云， 等. 二尖瓣手术后重度三尖瓣反流患者的临床特征及治疗.中国胸心血管外科临床杂志，2008，15（3）：170-173.
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朱鹏， 肖锡俊， 唐红， 等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察.中国胸心血管外科临床杂志， 2008， 15（4）：245-248.
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Ghanta RK， Chen R， Narayanasamy N， et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation：midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg， 2007， 133（1）：117-126.
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Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg， 2003， 125（3）：S9-S11.
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Rogers JH， Bolling SF. The tricuspid valve：current perspective and evolving management of tricuspid regurgitation. Circulation， 2009， 119（20）：2718-2725.
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Dreyfus GD， Corbi PJ， Chan KM， et al. Secondery tricuspid regurgitation or dilatation：which should be the criteria for surgical repair? Ann Thorac Surg， 2005， 79（1）：127-132.
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Icumi C， Iga K， Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis， 2002， 11（3）：353-356.
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Matsugama K， Matsumota M， Sugita T， et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg， 2003， 75（6）：1826-1828.
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Fukuda N， Oki T， Iuchi A， et al. Tricuspid inflow and regurgitation flow dynamics after mitral valve replacement：differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis， 1997， 6（2）：184-188.
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Shiran A， Sagie A. Tricuspid regurgitation in mitral valve disease incidence， prognostic implications， mechanism and management. J Am Coll Cardiol， JACC， 2009， 53（5）：401-408.
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Groves PH， Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis， 1992， 1（1）：80-86.
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McCarthy PM， Bhudia SK， Rajeswaran J， et al. Tricuspid valve repair：Durability and risk factors for failure. J Thorac Cardiovasc Surg， 2004， 127（3）：674-685.
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- 1. Surg， 2010， 22（1）：84-89.
- 2. Bernal JM， Gutiérrez-Morlote J， Llorca J， et al. Tricuspid valverepair：an old disease， a modern experience. Ann Thorac Surg， 2004， 78（6）：2069-2075.
- 3. Colombo T， Russo C， Ciliberto GR， et al. Tricuspid regurgitation secondary to mitral valve disease：tricuspid annulus function as guide to tricuspid valve repair. Cardiovas Surg， 2001， 9（4）：367-377.
- 4. Naqshloand MS， Abid AR， Akhtar RP et al. Functional tricuspid regurgitation in rheumatic heart disease：surgical options. Ann Thorac Cardicovasc Surg， 2010， 16（6）：417-425.
- 5. Rogers JH， Bolling SF. Valve repair for functional tricuspid valve regurgitation：anatomical and surgical considerations. Semin Thoracic.
- 6. 肖锡俊， 袁宏声， 唐红， 等. 二尖瓣置换术后三尖瓣反流的逆转、残留或加重.中国胸心血管外科临床杂志， 2006， 13（5）：307-310.
- 7. 肖锡俊， 袁宏声， 黄云， 等. 二尖瓣手术后重度三尖瓣反流患者的临床特征及治疗.中国胸心血管外科临床杂志，2008，15（3）：170-173.
- 8. 朱鹏， 肖锡俊， 唐红， 等. 以三尖瓣瓣环径作为三尖瓣成形手术指征的初步临床观察.中国胸心血管外科临床杂志， 2008， 15（4）：245-248.
- 9. Ghanta RK， Chen R， Narayanasamy N， et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation：midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg， 2007， 133（1）：117-126.
- 10. Frater R. Tricuspid insufficiency. J Thorac Cardiovasc Surg， 2003， 125（3）：S9-S11.
- 11. Rogers JH， Bolling SF. The tricuspid valve：current perspective and evolving management of tricuspid regurgitation. Circulation， 2009， 119（20）：2718-2725.
- 12. Dreyfus GD， Corbi PJ， Chan KM， et al. Secondery tricuspid regurgitation or dilatation：which should be the criteria for surgical repair? Ann Thorac Surg， 2005， 79（1）：127-132.
- 13. Icumi C， Iga K， Konishi T. Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease. J Heart Valve Dis， 2002， 11（3）：353-356.
- 14. Matsugama K， Matsumota M， Sugita T， et al. Predictors of residual tricuspid regurgitation after mitral valve surgery. Ann Thorac Surg， 2003， 75（6）：1826-1828.
- 15. Fukuda N， Oki T， Iuchi A， et al. Tricuspid inflow and regurgitation flow dynamics after mitral valve replacement：differences relating to surgical repair of the tricuspid valve. J Heart Valve Dis， 1997， 6（2）：184-188.
- 16. Shiran A， Sagie A. Tricuspid regurgitation in mitral valve disease incidence， prognostic implications， mechanism and management. J Am Coll Cardiol， JACC， 2009， 53（5）：401-408.
- 17. Groves PH， Hall RJ. Late tricuspid regurgitation following mitral valve surgery. J Heart Valve Dis， 1992， 1（1）：80-86.
- 18. McCarthy PM， Bhudia SK， Rajeswaran J， et al. Tricuspid valve repair：Durability and risk factors for failure. J Thorac Cardiovasc Surg， 2004， 127（3）：674-685.
