Comparison Of Outcomes Of Different Surgical Methods For 80 Cases Of Severe Tricuspid Regurgitation Secondary To Left-sided Heart Valve Disease

Background and Objective:Tricuspid regurgitation can be divided into organic regurgitation and functional regurgitation.Organic tricuspid regurgitation is rare when compared to mitral and aortic valve disease.Tricuspid regurgitation often occurs secondary to left-sided heart valve disease and has important clinical implications.Tricuspid regurgitation?TR?secondary to rheumatic left valvular disease accounts for about 50%of the disease,most of which is functional Tricuspid Regurgitation?FTR?.The formation of FTR is because of left ventricular valve disease or congenital heart disease with left-to-right shunt causing pulmonary hypertension,which leads to right ventricular enlargement,tricuspid annulus enlargement and?or?leaflet malcoaptation.The subvalvular apparatus?chords and papillary muscles?are morphologically normal.Tricuspid valve as the atrioventricular valve of the right heart which is a low pressure system,is closely related to right ventricle function.In most cases,tricuspid insufficiency is secondary to right heart failure.In most cases,due to the more prominent effects of other valves,cardiac surgeons tend to overlook the tricuspid valve during clinical treatment.Because of the low impact of tricuspid valve compared to other valve diseases,there is almost no special invention of tricuspid valve surgery,whether it is reconstruction or repair technology,similar to the design of mitral valve surgery.At present,due to the continuous development of various diagnostic techniques,the tricuspid valve gradually reflects its importance in cardiac surgery.The deterioration of the tricuspid valve may lead to a series of changes such as right heart failure,which will affect the quality of life of patients.The choice of tricuspid valve surgery is also related to the pathology and etiology of tricuspid valve disease.The continuous improvement of valve repair technologies and the studies of valve replacement materials provide the more and better choices for tricuspid valve treatment.Functional tricuspid regurgitation secondary to left-sided heart valve disease,in most cases,through tricuspid valve repair of light to moderate TR can play a good clinical efficacy^[5].Tricuspid valve suture annuloplasty?such as:Kay's angioplasty?,generally can achieve good effects in the short term,but for some poor repair or valve repair failure we need TVR.In recent years,aggressive tricuspid valve ring plasty?TVrP?is often used for severe FTR.This type of operation is mostly performed in the same period of left-sided heart valve surgery and achieves good short-term clinical efficacy^[5].However,some patients with TVrP still have some long-term recurrence of TR after surgery,which affects their long-term quality of life and survival.In the case of FTR patients with recurrent rate of left-sided heart valve surgery,clinical studies have shown that the recurrent rate in the long term tricuspid regurgitation after TVR is lower than TVrP^[7].However,there are few studies on the effect of tricuspid valve ring plasty and tricuspid valve replacement for severe FTR.There is still much controversy about which surgical procedure to choose.Therefore,the purpose of this study was to compare the short term and long term efficacies of tricuspid valve ring plasty?TVrP?and TVR in the treatment of severe tricuspid regurgitation?TR?in the hope of finding the best treatment for severe FTR.Methods:Retrospective analysis of 80 cases of TR patients received TV prosthetic annuloplasty or replacement during January 2008 to January 2013,of which 42patients underwent simultaneous Mitral Valve Replacement?MVR?and 18 patients simultaneously.MVR and aortic valve replacement were performed in 38 cases of atrial fibrillation ablation and MVR at the same time.Coronary artery bypass graft?CABG?and MVR were performed simultaneously in 4 cases.All patients underwent heart valve surgery with either tricuspid or tricuspid valve replacement.Of the 80patients,38 underwent valve replacement at the same time,known as the tricuspid valve replacement?TVR?group,and 42 patients underwent the formation of a ring angioplasty at the same time,known as the tricuspid valve ring plasty?TVrP?group.There was no significant difference in age,gender,right atrial diameter,right ventricular diastolic diameter,pulmonary arterial pressure,and left ventricular ejection fraction?LVEF??P>0.05?.Duration of aortic blockade,Cardiopulary bypass duration?CPB?,Length of stay in the Intensive Care Unit?ICU?,5-year recurrence rate,5-year survival rate after perioperative and postoperative Observe and compare.Results:There was no significant difference in the general clinical data between TVR group and TVrP group?P>0.05?.Perioperative mortality:There were 5 patients died in the valve replacement group and 1 in the forming ring group.There was no significant difference between the two groups?P>0.05?.The 5-year survival rate of the two groups was followed-up:3 deaths in total,2 deaths in the 5-year follow-up in the TVR group,and 1 death in the 5-year follow-up in the TVrP group.There was no significant difference in mortality between the two groups?P>0.05?.).Two-dimensional echocardiography at 2 weeks postoperatively showed that the tricuspid regurgitation?TR?in all cases was significantly lower than before surgery?P<0.05?.Thirty-one patients in the TVR group had mild or mild TR during follow-up,and 39 patients in the TVrP group had significant differences from preoperative TR levels?P<0.05?.However,there was no significant difference in TR degree between the TVRP and TVRP groups at 2 weeks after operation?P>0.05?.Two weeks after operation,color Doppler echocardiography showed that the right atrium diameter?RAD?,right ventricular diastolic diameter?RVDd?,pulmonary artery systolic pressure?PASP?and left ventricular ejection fraction?LVEF?were significantly improved compared with preoperative.There was a statistically significant difference compared with preoperative?P<0.05?.There was no significant difference between TVRP group and TVrP group?P>0.05?.Five-year color Doppler echocardiography showed that there were 26 cases and 9 cases of mild TR patients in the TVR and TVrP groups,respectively,2 cases and 18 cases of mild to moderate TR patients,3 cases and 13 cases respectively.In patients with moderate or more TR,there was a significant difference in TR between moderate TVR group and TVrP group?P<0.05?.Color Doppler echocardiography showed that the cardiac hyperparameters were measured at the 5-year follow-up:right atrium diameter?RAD?,right ventricular diastolic diameter?RVDd?,pulmonary systolic pressure?PASP?,and left ventricular ejection fraction?LVEF?.Was higher than preoperative?P<0.05?,but there was no significant difference between the two groups?P>0.05?.There was no significant difference in NYHA functional class between TVR group and TVrP group?P>0.05?.Conclusions:Compared with TVrP,TVR has acceptable short-term and long-term outcomes for the treatment of severe functional TR.TVR is an effective option for the patients unsuitable to perform TVrP.