The Primary Observation: Tricuspid Annulus As Guide To Tricuspid Valve Repair

ObjectivePrimary investigate whether reduce the moderate-severe tricuspid regurgitation after the left cardiac surgery, the surgical indication to tricuspid annuloplasty was considered in patients tricuspid annulus diameter≥21mm/m~2; the multiple factor analysis for the influence factor of the tricuspid annulus and tricuspid regurgitation in patients with left cardiac valve disease.MethodsThe left cardiac valve disease patients consistent with required to bring into investigates. All clinic records be registered. All patient were separated into two the tricuspid valve plastic group and non-tricuspid valve plastic group by echocardiographic tricuspid annulus diameter＜21mm/m~2, all patients underwent left cardiac valve replacement. Kay annutoplasty was performed in patients with tricuspid annulus diameter≥21mm~2/m. The echocardiographic data that were measured and calculated at preoperative and 6 month late include: chambers heart, tricuspid annuloplasty (end-diastole), tricuspid tethering distance, degree of tricuspid regurgitation left cardiac systolic function, right cardiac systolic function and pulmonary hypertension. The data, collected included general clinical signs cardiopulmonary bypass, preoperational and 6 month late' echocardiography were compared. The measure and calculate echocardiography data were subject contract compared. The multiple factor analysis for the influence factor of the tricuspid annulus and tricuspid regurgitation in patients with left cardiac valve disease.Results1. 1.56 patients (pts) with left cardiac valve disease join in this investigate, discharge with recovered. All finish follow up excluded 2 patients.2. TVP group include 22 pts, 33～58 years old (average 44.95±7.66 years); male 8 pts, female 14 pts; body surface area(BSA) 1.29～1.84m~2 (average 1.57±0.15m~2); atrial fibrillation 20 pts, sinus 2 pts; NYHAⅢ18 pts,Ⅲ～Ⅳ4 pts. NTVP group include 34 pts, 20～60 years old (average 42.95±11.02 years); male 9 pts, female 25 pts; body surface area 1.37～1.85m~2 (average 1.58±0.13m~2); atrial fibrillation 25 pts, sinus 9 pts; NYHAⅢ18 pts,Ⅲ～Ⅳ6 pts. There is no significant difference in ages sex BSA cardiac rhythm and heart function among group TVP or NTVP (P＞0.05).3. The clamp time of TVP 65.18±24.52min, assist time 98.36±28.95min, deepest oesophagus temperature 26.11±1.19℃; the clamp time of NTVP 59.00±18.00min, assist time 92.90±23.18min, deepest oesophagus temperature 26.29±1.1℃. There is no significant difference in cardiopulmonary bypass index among TVP or NTVP (P＞0.05).4. Peroperatively, chamber heart of TVP or NTVP: left ventricle 50.23±7.92mm, 48.03±8.19mm; left atrium 56.85±16.00mm, 48.15±10.20mm, right ventricle 20.62±3.17mm, 21.41±5.24mm, fight atrium 49.77±7.13mm, 44.56±8.33mm. Peroperatively, LA and RA of groups TVP are all larger than Group NTVP, there is significant different among Groups TVP, and Groups NTVP (P＜0.05); preoperatively there is not significant different among LV and RV of Groups TVP and NTVP. (P＞0.05)5. The preoperative and postoperative chamber heart of Groups TVP: LV 50.23±7.92mm, 46.67±7.51mm, LA 56.85±16mm, 45.43±10.17mm, RV 20.62±3.17mm, 19.57±3.33mm, RA 49.77±7.13mm, 44.14±8.91mm; LV, LA,RA of Groups TVP are all significantly smaller than preoperatively, Postoperative LV, LA, RA of Groups TVP are all significantly differences than preoperatively LV, LA, RA(P＜0.05), except RV.6. The preoperative and postoperative chamber heart of Groups NTVP: LV 48.03±8.19mm, 46.85±4.89mm, LA 48.15±10.20mm, 43.70±9.71mm, RA 44.56±8.33mm, 42.55±7.58mm, RV 21.41±5.24mm, 19.94±2.44mm; LA of Groups NTVP are significantly smaller than preoperatively, Postoperative LA of Groups NTVP are all significantly differences than preoperatively LA (P＜0.05), except LV, RA, RV.7. Preoperatively, tricuspid annulus of Groups TVP: 29.00～45.40mm (average 36.75±3.81mm); tricuspid annulus of Groups NTVP: 20.20～39.00mm (average 28.53±4.37mm). Preoperative tricuspid annulus of Groups TVP is significantly larger than the group NTVP, the difference is obviously. Tricuspid tethering distance of Group TVP: 0～2.01mm (average 0.46±0.67mm), tricuspidtethering distance of group NTVP: 0～1.39mm (average 0.16±0.37mm). There is no significant difference tricuspid tethering distance among Groups TVP and NTVP (P＞0.05).8. Preoperatively, 7 pts have not tricuspid regurgitation, 15 pts with mild tricuspid regurgitation in Groups TVR 20 pts have not tricuspid regurgitation, 14 pts with mild tricuspid regurgitation. There is significant difference tricuspid regurgitation between groups TVP and NTVP (P＜0.05). The mild tricuspid regurgitation of pts in groups TVP more than groups NTVP.9. Preoperatively, 7 pts in groups TVP have not tricuspid regurgitation, 15 pts with mild tricuspid regurgitation in groups TVP.Postoperatively, 19 pts in groups TVP have not tricuspid regurgitation, 3 pts with mild tricuspid regurgitation in Groups TVP. Postoperatively no tricuspid regurgitation pts increase in groups TVP, the mild tricuspid regurgitation pts lower than preoperatively. The tricuspid regurgitation constituent ratio significant difference between preoperatively and postoperatively (P＜0.05).10. Preoperatively, 20 pts in groups NTVP have not tricuspid regurgitation, 14 pts with mild tricuspid regurgitation in groups NTVP.Postoperatively, 26 pts in groups NTVP have not tricuspid regurgitation, 5 pts with mild tricuspid regurgitation and 3 pts with moderate tricuspid regurgitation in Groups NTVP. The tricuspid regurgitation constituent ratio was no significant difference between preoperatively and postoperatively (P＜0.05).11. Postoperatively, 19 pts with no tricuspid regurgitation, 3 pts has mild; 25 pts with no tricuspid regurgitation, 5 mild and 3 moderate. There is no significantly difference between tricuspid regurgitation constituent ration after operation (P＞0.05).12. Preoperatively, the cardiac function of groups TVP and NTVP: left ventricular ejecting fraction (EF) 0.57±0.11, 0.63±0.09; left ventricular fractional shortening (FS) 0.30±0.07, 0.35±0.07; right ventricular EF 0.55±0.11, 0.58±0.11; right ventricular Tei index 0.4±0.24, 0.46±0.25; Properatively, left ventricular function of groups TVP is significantly smaller than the groups NTVP, except right ventricular EF and Tei index (P＞0.05).13. Properatively, the pulmonary hypertension of Groups TVP was 31.27±17.80mmHg, the pulmonary hypertension of Groups NTVP was 21.47±16.77mmHg.the pulmonary hypertension of groups TVP is significantly larger than the groups NTVP, and the difference is larger (P＜0.05).14. Postoperatively, the cardiac function of groups TVP and NTVP: left ventricular EF: 0.60±0.11, 0.62±0.09; left ventricular FS: 0.34±0.08, 0.34±0.07; right ventricular EF: 0.58±0.09, 0.57±0.11; right ventricular Tei index 0.38±0.14, 0.36±0.25. Preoperatively, there is no significantly difference between groups TVP and NTVP (P＞0.05).15. The preoperative or postoperative cardiac function of groups TVP: left ventricular EF 0.57±0.11, 0.60±0.11; left ventricular FS 0.30± 0.07, 0.34±0.08; fight ventricular EF 0.55±0.11, 0.58±0.09; right ventricular Tei index: 0.4±0.24, 0.38±0.14. Postoperative left ventricular FS is significantly larger than preoperatively (P＜0.05), except left ventricular EF, right ventricular EF, right ventricular Tei index (P＞0.05).16. The preoperative or postoperative cardiac function of groups NTVP: left ventricular EF 0.63±0.09, 0.62±0.09; left ventricular FS 0.35±0.07, 0.34±0.07; fight ventricular EF 0.58±0.11, 0.57±0.11; right ventricular Tie index: 0.46±0.25, 0.36±0.25. There is no significantly difference between preoperative and postoperative (P＞0.05).17. Through the multiple regression analysis for preoperative tricuspid annulus, body surface areas left, ventricular EF, RA were identified as independent parameter. Through the logistic regression statistics for the factor of tricuspid regurgitation, tricuspid tethering distance and pulmonary hypertension as independent parameter.Conclusions:1. The choice to treat the tricuspid insufficiency according to indexed tricuspid annuls dimension (≥21mm/m~2) has been effective decrease the moderate-severe tricuspid regurgitation pts.2. The body surface area, RA and left ventricular function is relation with tricuspid annulus.3. The pulmonary hypertension and tricuspid tethering distance is relation with preoperatively left cardiac valve pts tricuspid regurgitation.