ObjectiveTo investigate the morbidity of postoperative pulmonary complications (PPCs) in patients after transcatheter tricuspid valve replacement (TTVR). MethodsA prospective cohort study enrolled 19 patients who were diagnosed with severe or greater tricuspid regurgitation in West China Hospital from October 11, 2020 to March 1, 2021, and would receive TTVR using LuX-valve for valve replacement. The patients were divided into a PPCs group and a non-PPCs group according to the presence of PPCs. The incidence of PPCs after tricuspid valve intervention between the two groups was compared. ResultsOf 19 patients diagnosed with severe or greater tricuspid regurgitation registered in the database, 17 met the inclusion criteria, including 15 females and 2 males, with a mean age of 68.4±8.0 years. PPCs occurred in 9 of 17 (52.9%) patients. At discharge, compared with the non-PPCs group, the PPCs group had a longer postoperative hospital stay [11.0 (10.0, 17.0) d vs. 7.5 (7.0, 8.0) d, P=0.01], longer ICU stay [72.0 (45.5, 95.0) h vs. 20.5 (16.0, 22.8) h, P<0.01], and more hospital cost [74.3 (65.9, 98.3) thousand yuan vs. 52.6 (44.2, 57.4) thousand yuan, P<0.01]. At 30 days of follow-up, the PPCs group was found that the rate of New York Heart Association cardiac function≥class Ⅲ (66.7% vs. 12.5%, P<0.01) was higher, the six-minute walk distance (170.2±169.3 m vs. 377.9±80.5 m, P<0.01) was shorter and Kansas City Cardiomyopathy Questionnaire heart failure score (40.9±31.2 vs. 80.4±5.8, P<0.01) was less than those of the non-PPCs group. ConclusionPPCs are common in the patients undergoing TTVR and severely affect patients' cardiac function, exercise function and quality-of-life recovery. Proactive preoperative intervention as well as early postoperative rehabilitation management should be provided to those at high risk of PPCs.
Objective To evaluate the right ventricular function of the patients 2 years after surgery by ultrasonic cardiography (UCG) who underwent mitral valve replacement (MVR) concomitant tricuspid annuloplasty (TAP). Method We finally identified 36 patients required MVR with tricuspid valve annular dilation concomitant merely mild tricuspid regurgitaion (TR) based on preoperative UCG in our hospital between April and November 2012 year. All patients were randomly divided into two groups by digital table including a tricuspid annuloplasty group (a TAP group, n=18, 7 males and 11 females at age of 45.67±12.49 years) and a no-tricuspid annuloplasty group (a NTAP group, n=18, 6 males and 12 females at age of 45.44±10.48 years). General clinical data and extracorporeal circulation data were recorded. UCG evaluation was practiced preoperation, alone with 1 week, 6 months, and 2 years after surgery. Results Two years postoperative maximal long-axis of RA (RAmla), mid-RA minor distance (RAmmd), right ventricle dimension-1(RVD1) , right ventricular fractional area change (RVFAC), 3D RV end-systolic volume (3DRVESV), tricuspid valve annular end-diastolic dimension (TVAEDD), tricuspid valve annular end-systolic dimension (TVAESD) of patients were all smaller in the TAP group than those in the NTAP group. Yet right ventricular ejection fraction (RVEF), percent shorting of tricuspid valve annulus (PSTVA) were greater in the TAP group than those in the NTAP group, although there was no statistical difference between the two groups in two years postoperative 3D RV end-diastolic volume (3DRVEDV). The patients in the TAP group had a superior trend than that of the NTAP group. Moreover, the patients' TR constituent ratio in the TAP group was much better than that of the NTAP group in 2 year after operation. Conclusions Concomitant tricuspid annuloplasty for patients with tricuspid valve annulus dilation and mild TR underwent MVR is favorable for the recovery of their 2 years postoperative function of tricuspid valve and right ventricle. It is benefit to reduce patient's long term postoperative TR residues and exacerbation.
Functional tricuspid valve regurgitation (TR) is often secondary to left-sided valvular heart diseases. The precise diagnosis of TR degree and reasonable treatment can improve the long-term prognosis of patient. Now we believe that rectifying the TR during left cardiac valve surgery can prevent a further development of TR and avoid the reducing of the cardiac function for patients with moderate TR, tricuspid valve annulus diameter>40 mm in late diastole, tricuspid valve diameter/body surface area>21 mm/m2, and intraoperative tricuspid valve diameter >70 mm, especially for patients with atrial fibrillation and atrial enlargement. The use of prosthetic ring can effectively prevent recurrence of TR in long term and we should try to use hard or semihard "C" shape prosthetic ring as much as possible. The tricuspid valve replacement should be avioded because of its higher mortality.
ObjectiveTo investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation. MethodsA retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done. They were 309 males and 152 females with a median age of 53.00 (44.00, 60.00) years. According to whether they received tricuspid valve repair (Kay’s annuloplasty, DeVega’s annuloplasty or annular ring implantation), the patients were divided into a mitral valve surgery only group (a nTAP group, n=289) and a concomitant tricuspid valve repair group (a TAP group, n=172). At the same time, 43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups. ResultsThe median follow-up duration was 3.00 years (range from 0.10 to 9.30 years). There was no perioperative death. Three months after surgery, the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group [–1.00 (–3.00, 1.00) mm vs. 0.00 (–0.20, 2.00) mm, P=0.048]. Three years after surgery, the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group [–1.00 (–2.75, 2.00) mm vs. 2.00 (–0.75, 4.00) mm, P=0.014], and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation (3.64% vs. 35.64%, P<0.001). Annuloplasty ring implantation was more effective in preventing regurgitation progression (P=0.044). For patients with a tricuspid annulus diameter less than 40 mm, concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up (P=0.036). Conclusion Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral valve surgery can effectively improve the tricuspid valve and right heart function in the early and mid-term after surgery. Annuloplasty ring implantation is more effective in preventing regurgitation progression. Patients whose tricuspid annulus diameter is less than 40 mm can also benefit from concomitant tricuspid repair.
Functional tricuspid regurgitation is referred to tricuspid regurgitation due to enlargement of right ventricular and dilation of tricuspid annulus. Patients with chronic progressive tricuspid regurgitation have poor prognosis, poor quality of life and heavy economic burden. This article provides a comprehensive review of functional tricuspid regurgitation in terms of anatomical basis, pathological stage, imaging assessment and surgical decision making.
Objective To examine the regression, residue, or progression of tricuspid regurgitation （TR） after mitral valve replacement so as to improve the clinical evaluation and management of TR. Methods From January 1998 to December 2003, a total of 287 consecutive patients of mitral valve replacement were followed and reviewed for this study. There were 86 male patients and 201 female patients whose ages ranged from 15 to 66 years （41.0±11.0 years）. The predominant mitral vane lesion was stenosis in 199 patients （69%）, regurgitation in 66 patients （23%） and mixed in 22 patients （8%）. A total of 201 patients （70%） had atrial fibrillation and 86 patients （30%） were in sinus rhythm. According to ratio of maximal regurgitation area to right atrial area TR was graded as mild （＋）, mild-moderate （＋/＋＋） moderate （＋＋） moderate-severe （＋＋/＋＋＋） and severe （＋＋＋）. There were 101 mild TR （36.7%）, 5 mild-moderate（1.8%）, 27 moderate （9.8%）, 2 moderate-severe （0.7%） and 21 severe （7.6%）. Depending on the surgical findings tricuspid annuloplasty was performed. The patients were followed in outpatient clinical and had echocardiography evaluation regularly. Results The follow-up ranged from 2 to 7 years （4.0±1.6 years）. Twelve patients were lost during the follow-up periods. Compared with preoperation, clinical condition of the majority of patients was improved after surgery. The diameter of left atrium, right atrium, left ventricle and right ventricle decreased significantly after operation （P〈0.01）. The ejection fraction and fraction of shorting increased significantly after surgery （P〈0.05）. However there were no significantly changes between pre- TR and post- TR in these patients （P〉0.05）. Tricuspid annuloplasty was not performed for 129 patients who had TR because TR was judged intraoperatively not to be severe. Of those patients, TR regressed in 54 patients, improved in 12 patients, did not change in 46 patients and progressed in 17 patients respectively after surgery. There were 27 patients who received De Vega tricuspid annuloplasty. Among them, TR regressed in 10 patients, improved in 12 patients and did not change in 5 patients respectively after surgery. Conclusion It is not adequate to evaluate the degree of TR in mitral valve diseases with rate of maximal regurgitation area to right atrial area. It should be improved to adopt intraoperative findings for tricuspid annuloplasty. TR may occur in patients who do not have TR before operation.
ObjectiveTo explore the clinical effect of LuX-Valve implantation in patients with severe tricuspid regurgitation (TR) and review articles about similar devices.MethodsWe reported the data of a 58-year-old male patient with severe TR, who was hospitalized on March 17th, 2020 because of “abdominal distention and edema for 5 years”, and then received LuX-Valve implantation in the Department of Cardiovascular Surgery of Changhai Hospital, Naval Medical University. Articles about transcatheter tricuspid valve replacement were reviewed in PubMed according to the key words including “transcatheter tricuspid valve replacement” “TTVR” and “transcatheter tricuspid valve intervention”.ResultsThe patient with severe TR received LuX-Valve implantation under general anesthesia and the guidance of digital subtraction angiography and transesophageal echocardiography. The patient’s TR was totally corrected after implantation and postoperative one-month follow-up showed well clinical effects. The result of literature review showed that there were two similar devices and both had been implanted in TR patients.ConclusionLuX-Valve is an effective and reliable transcatheter tricuspid valve replacement device.
Tricuspid regurgitation (TR) affects a wide population in China, and frequently coexists with other conditions as comorbidities. Moderate to severe TR is associated with a poor prognosis and medical treatment alone does not prevent progression of disease. Although minimal invasive catheter-based techniques might be an option for TR treatment in selected high risk patients, there is no relevant recommendations for the transcatheter treatment of TR in practice guidelines. Several transcatheter edge-to-edge repair devices are currently in preclinical and early clinical evaluation as potential novel treatment options for symptomatic TR in patients at increased risk for surgery, becoming as the most common technique applied for interventional TR treatment. Hence, the present study will introduce the clinical features of TR, the progress of edge-to-edge repair, and the application and challenges in the future.
A 23-year-old male patient was diagnosed with congenitally corrected transposition of great arteries (ccTGA) at the age of 3 years during a routine physical examination. Due to the absence of significant symptoms, the patient was managed conservatively with follow-up without surgical treatment. He developed chest tightness one year prior to admission, with symptom exacerbation in the recent month. Echocardiography demonstrated significantly worsened morphological tricuspid regurgitation. The patient presented to Guangdong Provincial People’s Hospital for surgical evaluation. Given the patient’s age and clinical presentation, a totally thoracoscopic morphological tricuspid valve replacement was performed. Postoperative assessment showed good prosthetic valve function, with no regurgitation or paravalvular leakage; the electrocardiogram confirmed sinus rhythm without atrioventricular block. Extubation occurred within 12 hours postoperatively, and the patient was transferred from the intensive care unit (ICU) on postoperative day 2. At the three-month follow-up, the patient was asymptomatic and had resumed normal activities. This report describes the first case of a totally thoracoscopic morphological tricuspid valve replacement in a ccTGA patient in China. This initial experience suggests that the totally thoracoscopic approach for morphological tricuspid valve replacement in ccTGA patients is a feasible, safe, and effective minimally invasive option associated with rapid recovery.
Recently, several transcatheter devices for aortic valve replacement and mitral valve repair have been used in clinic, and researchers have designed a variety of tricuspid valve (TV) intervention devices. We reviewed the current status of transcatheter TV intervention, and focused on the structures of these devices and the early results of clinical trials. Undoubtedly, transcatheter intervention for TV is promising, innovational and safe for patients with severe TV regurgitation.