These tools will no longer be maintained as of December 31, 2024. Archived website can be found here. PubMed4Hh GitHub repository can be found here. Contact NLM Customer Service if you have questions.


Pubmed for Handhelds

PUBMED FOR HANDHELDS

Search MEDLINE/PubMed

  • Title: [The mid-term outcomes of minimally invasive plasty for severe tricuspid regurgitation after cardiac surgery].
    Author: Huang HL, Ke YJ, Yang L, Yan Q, He BC, Zhou K, Chen ZR, Guo HM, Lu C, Liu J, Huang JS.
    Journal: Zhonghua Wai Ke Za Zhi; 2019 Dec 01; 57(12):902-907. PubMed ID: 31826593.
    Abstract:
    Objectives: To evaluate the efficacy of minimally invasive surgery in patients with late severe tricuspid regurgitation after cardiac surgery, and to evaluate the role of leaflets augmentation technique in tricuspid valvuloplasty. Methods: From January 2015 to June 2019, 85 patients undergoing tricuspid valve repair procedure with minimally invasive approach at Department of Cardiovascular Surgery, Guangdong provincial People's Hospital were enrolled. There were 22 males and 63 females, aging of (53.6±12.4) years (range: 15 to 75 years). The interval between the prior and current operations was (16.0±7.3) years (range: 0.2 to 35.0 years). The diameter of right atrium and right ventricle was (77.3±17.2) mm and (61.0±8.4) mm, respectively. Tricuspid regurgitation was severe or extremely severe, the tricuspid regurgitation area was (19.0±10.3) cm(2). All patients underwent minimally invasive tricuspid valvuloplasty or tricuspid valve replacement on beating-heart with totally endoscopic technique and port-access approach through right chest wall. The operations included tricuspid valve replacement and tricuspid valvuloplasty, the technique of tricuspid valvuloplasty including leaflets augmentation with patch, ring implantation, chordae tendineaes reconstruction, release of papillary muscle, edge to edge method, etc. Postoperative hospitalization days, the time of ICU stay, blood transfusion rate, ventilator time and the results of echocardiography were recorded. Follow-up was completed regularly by WeChat, telephone and outpatient visit. Results: Sixty-five patients underwent tricuspid valve repair, and 20 patients underwent tricuspid valve replacement because of prosthetic failure and plasty failure. Five patients died during hospitalization, with mortality rate 5.9%. One patient was transferred to local hospital for anti-infection treatment, the other 79 patients were discharged from hospital in well condition and followed-up. The postoperative hospitalization time was 7.0 (5.5) days (M(Q(R))) days, the mean ventilator time was 18.0 (16.2) hours, and the mean ICU stay time was 68.0 (75.5) hours. There were 35 patients without blood conduction transfusion, the transfusion rate was only 58.9% (50/85). Four cases of severe, 9 cases of moderate and 67 cases of mild to zero tricuspid regurgitation were examined before being discharged, with tricuspid regurgitation area of (2.8±3.5) cm(2) (range: 0 to 19.1 cm(2)). The follow-up time was 1 to 38 months. Two patients died during follow-up, one patient died from infective endocarditis and mitral perivalvular leakage, the other one died of intractable right heart failure. One patient was implanted with permanent pacemaker due to Ⅲ atrioventricular block. Valvular re-replacement was performed in 2 patients who were re-admitted for the artificial valve infection and mechanical valve obstruction. No re-operation of tricuspid valve. Conclusions: Totally endoscopic minimally invasive technique provided satisfactory surgical outcomes for critically sick patients with severe tricuspid regurgitation following cardiac surgery. The application of leaflets augmentation technique achieved ideal repair effect for previously unrepairable lesions. 目的： 探讨微创手术治疗心脏手术后远期重度三尖瓣关闭不全的中期疗效，明确瓣叶补片扩大在三尖瓣成形中的作用。 方法： 回顾性分析2015年1月至2019年6月因心脏术后远期重度或极重度三尖瓣关闭不全在广东省人民医院心外科接受微创成形手术的85例患者的临床资料。男性22例，女性63例，年龄（53.6±12.4）岁（范围：15~75岁）。三尖瓣手术与前次手术的间隔时间为（16.0±7.3）年（范围：0.2~35.0年）。右心房和右心室内径分别为（77.3±17.2）mm和（61.0±8.4）mm。三尖瓣反流为重度或极重度，三尖瓣反流面积为（19.0±10.3）cm(2)。采用右侧胸壁打孔和全胸腔镜技术，行心脏不停跳下三尖瓣成形。三尖瓣成形技术包括瓣叶补片扩大、瓣环植入、人工腱索重建、乳头肌松解、双孔法等。记录术后住院时间、ICU停留时间、输血情况、机械通气时间及超声心动图。通过微信、电话、门诊等方式进行随访。 结果： 65例患者顺利完成三尖瓣成形，20例患者因三尖瓣人工瓣膜衰败及三尖瓣成形失败改行三尖瓣置换。住院期间死亡5例（5.9%），1例患者转当地医院继续治疗，其余79例患者均康复出院并全部获得随访。术后住院时间为7.0（5.5）d[M（Q(R)）]，机械通气时间为18.0（16.2）h，ICU停留时间为68.0（75.5）h。41.1%（35/85）的患者未输注任何血制品。出院复查超声心动图，三尖瓣反流重度4例，中度9例，无或轻度67例，残余三尖瓣反流面积为（2.8±3.5）cm(2)（范围：0~19.1 cm(2)）。术后随访1~38个月，随访期间死亡2例，1例死于感染性心内膜炎和瓣周漏，另1例死于顽固性右心功能不全。因Ⅲ度房室传导阻滞植入永久性起搏器1例，因人工瓣膜感染和机械瓣梗阻再次入院行二尖瓣和主动脉瓣再次置换各1例，无再次三尖瓣手术患者。 结论： 全胸腔镜微创技术治疗心脏术后重度三尖瓣关闭不全可获得满意的手术效果，瓣叶补片扩大技术可使之前无法修复的病变获得理想的成形效果。.
    [Abstract] [Full Text] [Related] [New Search]