ObjectiveTo compare the outcomes of mechanical prosthetic versus bioprosthetic replacement of tricuspid valve. Methods We retrospectively analyzed the clinical data of 344 patients underwent tricuspid valve replacement (TVR) in Guangdong General Hospital between January 2000 and December 2010. There were 227 female and 117 male patients with their age of 8-74 (42.0±13.3) years. We allocated the patients into two groups: 168 patients (48.8%) at age of 37.0±11.6 years underwent mechanical tricuspid valve replacement (the MTVR group) and 176 (51.2%) patients at age of 46.0±13.4 years underwent biological tricuspid valve replacement (the BTVR group). Follow-up data were obtained via patients' visiting the outpatient clinic, telephone or mail contacts. ResultsThe mean follow-up time was 5.7 years (ranged from 2 months to 12.6 years). In the BTVR group, 149 patients survived to discharge from hospital, and 144 patients were followed-up successfully, giving a 96.6% follow-up rate. Early mortality (within 30 days post-operation) occurred in 29 patients (16.5%), and 14 patients (7.9%) died after 30 days post-operation. Eighteen bioprosthetic valve degeneration was found during follow-up, and infective endocarditis in 3 patients. In the MTVR group, 152 patients survived to discharge from hospital, 142 patients (93.4%) were followed-up. Early mortality in 13 patients (7.7%), and 14 patients (8.3%) died after 30 days post-operation. Nineteen patients suffered from mechanical prosthesis obstruction, no infective endocarditis patients was found in the MTVR group. There was no statistical difference between the BTVR group and the MTVR group in mortality rate (24.4% versus 16.1%, P=0.054) and in reoperation rate (4.2% versus 9.9%, P=0.051), respectively．There were statistical differences in long-term survival rates between the BTVR group and the MTVR group with 1 year survival rate(78% vs. 89%), 5 years survival rate(74% vs. 86%), and 10 years survival rate (66% versus 78%) with P value at 0.003. ConclusionsThis study suggests that the type of implanted prosthesis in tricuspid replacement does not affect long-term outcomes or the reoperation rate. The survival rate is higher in the MTVR group than that in the BTVR group, which may contribute to younger age in the MTVR group. There is a tendency in higher infective endocarditis incidence in the BTVR group than that in the MTVR group.
One of its primary surgical treatments of tricuspid regurgitation is tricuspid valve biological valve replacement. Catheter tricuspid valve-in-valve implantation is a novel interventional alternative for biological valve failure. The non-invasive lung fluid measuring device remote dielectric sensing (ReDSTM) has been increasingly incorporated into clinical practice as a means of monitoring chronic heart failure in recent years. This report describes the process and outcomes of the first instance of perioperative lung fluid volume evaluation following transcatheter tricuspid valve implantation utilizing ReDSTM technology. The patient has a short-term, substantial increase in postoperative lung fluid volume as compared to baseline.
Objective To analyze and explore the risk factors of secondary tricuspid regurgitation (TR) after left-sided valve surgery (left cardiac valve replacement or valvuloplasty) using meta-analysis, so as to provide evidence for clinical diagnosis and treatment of secondary TR. Methods We electronically searched databases including PubMed, MEDLINE, CBM, CNKI, VIP, for literature on the risk factors of secondary TR after left-sided valve surgery from 1995 to 2012. According to the inclusion and exclusion criteria, we screened literature, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0 software. Results A total of 6 case-control studies were included, involving 437 patients and 2 102 controls. The results of meta-analysis showed that, the risk factors of progressive exacerbation of secondary TR after left-sided valve surgery included preoperative atrial fibrillation (OR=3.90, 95%CI 3.00 to 5.07; adjusted OR=3.04, 95%CI 2.21 to 4.16), age (MD=5.36, 95%CI 3.49 to 7.23), huge left atrium (OR=5.17, 95%CI 3.12 to 8.57; adjusted OR=1.91, 95%CI 1.49 to 2.44) or left atrium diameter (MD=4.85, 95%CI 3.18 to 6.53), degradation of left heart function (OR=2.97, 95%CI 1.73 to 5.08), rheumatic pathological change (OR=3.06, 95%CI 1.66 to 4.68), preoperative TR no less than 2+ (OR=3.52, 95%CI 1.26 to 9.89), and mitral valve replacement (MVR) (OR=2.35, 95%CI 1.68 to 3.30). Sex (OR=1.54, 95%CI 0.94 to 2.52) and preoperative pulmonary arterial hypertension (OR=1.28, 95%CI 0.77 to 2.12) were not associated with secondary TR after left-sided valve surgery. Conclusion The risk factors of progressive exacerbation of secondary TR after left-sided valve surgery include preoperative atrial fibrillation, age, huge left atrium or left atrium diameter, degradation of left heart function, rheumatic pathological change, preoperative TR no less than 2+, and MVR. Understanding these risk factors helps us to improve the long-time effectiveness of preventing and treating TR after left-sided valve surgery.
Abstract： Ebstein anomaly is a relatively rare congenital heart malformation which can affect heart function significantly. It may cause right heart failure, even whole heart failure and eventually death. In recent years, the surgery has made much progress in dealing with the abnormal valve, improving the right ventricle function and pretreatment of its related complications. However, because of its complexity and diversity in pathological anatomy and clinical manifestations, the disease has not got an “almighty standard” to treat all pathological anatomy types of the deformity, or asurgery strategy to solve the practical problems encountered in all clinic situations. Furthermore, the therapeutic effect is also unsatisfactory. This article will review the advance of treatment of Ebstein anomaly and prevention of its related complications.
The apical displacement of tricuspid valve leaflets complicated with significantly enlarged, thin and fibrotic wall of the right ventricle is prone to dysfunction of right heart. Therefore, the myocardial protection for the right ventricle is important. Based on the pathological changes, an algorithm of perioperative myocardial protection strategy is summarized. Firstly, we should clearly know that the right ventricular myocardium with severe lesions is much different from the unimpaired myocardium, because it is now on the margin of failure; secondly, right heart protection should be regarded as a systematic project, which runs through preoperative, intraoperative and postoperative periods, and requires close collaboration among surgeons, perfusionists, anesthesiologists and ICU physicians. In this article, we try to introduce the systematic project of the right heart protection, in order to improve the outcome of this population.
Abstract: Objective To summarize the clinical experience of 13 patients of tricuspid valve replacement and to investigate the indication and method. Methods From January 1994 to December 2005, the clinical datum of the thirteen patients suffering from tricuspid valve disease were reviewed, including rheumatic heart disease 6 cases, congenital heart disease 3 cases, infective endocarditis 3 cases and right ventricular tumor 1 case. All the cases underwent tricuspid valve replacement. Results Two reoperative rheumatic heart disease patients died early after operation and their cardiac function was New York Heart Association (NYHA) class Ⅳ before operation. The followup interval was 3 months to 12 years in 11 cases. There were 2 late death, one died of recurrence of infective endocarditis, and another died of the recurrence of the tumor. One Ebstein anomaly case’s NYHA functional recovered to class Ⅲ, eight cases’s recovered to NYHA classⅠ-Ⅱ. Conclusion The tricuspid valve disease may be a secondary lesion from many causes. Indication of tricuspid valve replacement must be strictly commanded. The late results of tricuspid valve mechanical prostheses replacement is satisfactory.