Minimally Invasive Tricuspid Valvuloplasty for Isolated Regurgitation Following Left Heart Valve Replacement in Rheumatic Valve Disease

Huanlei Huang, Zerui Chen, Huiming Guo, Biaochuan He, Qingshi Zeng, Yingjie Ke, Ren Zhu, Qian Yan, Xiaohua Zhang, Jingsong Huang, Jingsong Huang, Jing Liu, Cong Lu

Guangdong Gerneral Hospital, Guangzhou, China

Date, time and location: 2018.05.27 10:30, Congress Hall, 2F–C

Abstract

Objective: To evaluate the feasibility and efficacy of a combination of minimally invasive approach and a variety of valve repair techniques treating isolated tricuspid regurgitation(TR) after left heart valve replacement.

Methods: From Jan 2015 through Dec 2017, patients with severe TR undergoing re-operative tricuspid valve repair (TVP) with a combination of minimally invasive approach and multiple repair techniques were enrolled, all of them were diagnosed rheumatic valve disease in previous surgeries. The procedures were performed on beating heart with normothermic peripheral CPB, and minimally invasive access through right lateral thoracotomy. Techniques of TVP including leaflets augmentation, artificial chordae implantation, papillary muscle release, and ring implantation.

Results: Thirty-five adult patients were enrolled (7 male), mean age and weight was 54.6±9.4 years and 55.9±10.8 Kg. Previous cardiac surgery included MVR and DVR in 17 and 18, eleven of them had previous TVP including Devega’s procedure in 9 and ring implantation in 2. One patients transferred to median sternotomy, 34 underwent totally endoscopic TVP. Out of 35 patients, 5 with functional TR undergoing ring implantation, 30 with organic lesion undergoing leaflets augmentation and ring implantation. Other repair techniques were also applied for organic lesion including papillary muscle release in 15, artificial chordae in 4, and commissurotomy in 3. The operation time, CPB time, ventilation and postoperative hospital stay was 4.3±1.2 hours,139±52.2 min, 79.7±180.2 hours, and 13.7±11.8 d, respectively. The TR jet area was decreased from 22.7±10.8cm² to 3.6±3.5cm² after TVP according to the latest echocardiography (p<0.001). All patients were followed-up for 11.3±5.6 months (range, 4-19), 1 patient underwent Re-AVR, no late death.

Conclusion: Minimally invasive approach is a safe and reliable option for re-operative TVP, and leaflets augmentation is effective in treating severe organic TR after left heart valve replacement in rheumatic valve disease.