Leaflet extension in reoperation after tricuspid valve repair in children_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LIU Hao , TANG Min , HE Yi ,  MEI Ju

Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200082, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Leaflet extension; children; anticoagulation therapy; therapeutic effect

DOI：

10.7507/1007-4848.201606012

Video：

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Objective To summarize our experience on leaflet extension in reoperation after tricuspid valve repair in children at age≤15 years and to explore the application indicators and skills of this technique. Methods We retrospectively analyzed the clinical data of 23 children who underwent reoperation after tricuspid valve repair in Xinhua Hospital between January 2006 and October 2015. There were 15 males and 8 females with a mean age of 8.7 years, ranging from 5 to 15 years. The leaflet was extended by artificial pericardium patch. After surgery, warfarin anticoagulation therapy was done, and international normalized ratio was maintained 2.0 to 3.0. Results The average cardiopulmonary bypass time was 87-132 (98.5±35.7) minutes, and average aortic cross-clamping time was 56-97 (68.40±23.78) minutes. One patient died in hospital. There were 3 patients with complications including respiratory failure in 1 patient, acute renal failure in 1 patient, and right heart insufficiency in 1 patient. All the children cured and were followed up for 5 months to 10 years, with a mean follow-up of 3.5 years. One patient died during the follow-up. Six patients suffered mild to moderate tricuspid regurgitation and tricuspid valve function of the rest patients was good. No other redo-valve surgery or complications correlated to anticoagulation occurred. Conclusion Leaflet extension in reoperation after tricuspid valve repair in children is useful with optimistic middle to long term efficacy and needs intensive care therapy during the perioperative period.

Citation： LIU Hao, TANG Min, HE Yi, MEI Ju. Leaflet extension in reoperation after tricuspid valve repair in children. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2017, 24(4): 265-268. doi: 10.7507/1007-4848.201606012 Copy

1.	Anselmi A, Ruggieri VG, Harmouche M, et al. Appraisal of long-term outcomes of tricuspid valve replacement in the current perspective. Ann Thorac Surg, 2016, 101(3): 863-871.
2.	Hwang HY, Kim KH, Kim KB, et al. Reoperations after tricuspid valve repair: re-repair versus replacement. J Thorac Dis, 2016, 8(1): 133-139.
3.	Nishimura RA, Otto CM, Bonow RO, et al. 2104 AHA/ACC guideline for the management of the patients with valvular heart disease: a report of the American College of Cardiolagy/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
4.	Chikwe J, Itagaki S, Anyanwu A, et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol, 2015, 65(18): 1931-1938.
5.	Cha BK, Kuh JH, Choi JB. Leaflet augmentation for treating tricuspid valve regurgitation: indications and the patch size. J Card Surg, 2015, 30(12): 903-904.
6.	Said SM, Burkhart HM, Schaff HV, et al. When should a mechanical tricuspid valve replacement be considered? J Thorac Cardiovasc Surg, 2014, 148(2): 603-608.
7.	Pfannmüller B, Moz M, Misfeld M, et al. Isolated tricuspid valve surgery in patients with previous cardiac surgery. J Thorac Cardiovasc Surg, 2013, 146(4): 841-847.
8.	Jeganathan R, Armstrong S, Al-Alao B, et al. The risk and outcomes of reoperative tricuspid valve surgery. Ann Thorac Surg, 2013, 95(1): 119-124.
9.	Herzer R, Hacje P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein’s anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
10.	Bevan PJ, Haydock DA, Kang N. Long-term survival after isolated tricuspid valve replacement. Heart Lung Circ, 2014, 23(8): 697-702.
11.	De Meester P, Van De Bruaene A, Voigt JU, et al. Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: retrospective single center analysis. Int J Cardiol, 2014, 175(2): 333-339.
12.	Dillon J, Yakub MA, Nordin MN, et al. Leaflet extension in rheumatic mitral valve reconstruction. Eur J Cardiothorac Surg, 2013, 44(4): 682-689.
13.	Dillon J, Yakub MA, Kong PK, et al. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: Is repair for " burnt-out” rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg, 2015, 149(3): 771-779.
14.	Pettinari M, Bertrand P, Van Kerrebroeck C, et al. Mid-term results of leaflet augmentation in severe tricuspid functional tethering. Eur J Cardiothorac Surg, 2016, 50(3): 504-508.
15.	Parolari A, Barili F, Pilozzi A, et al. Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review. Ann Thorac Surg, 2014, 98(6): 2255-2263.
16.	刘浩, 梅举, 汤敏, 等. 儿童心瓣膜置换术患者的临床特点及中远期随访. 中国胸心血管外科临床杂志, 2015, 22(5): 446-449.
17.	Nguyen N, Sharathkumar A. Current perioperative anticoagulation practices in children with prosthetic mechanical heart valves. Congenit Heart Dis, 2015, 10(5): E210-E215.
18.	Emani SM, Piekarski BL, Zurakowski D, et al. Concept of an expandable cardiac valve for surgical implantation in infants and children. J Thorac Cardiovasc Surg, 2016, 152(2): 1514-1523.
19.	Xiao J, Yin L, Lin Y, et al. A 20-year study on treating childhood infective endocarditis with valve replacement in a single cardiac center in China. J Thorac Dis. 2016, 8(7): 1618-1624.
20.	David TE. Aortic valve replacement in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2871-2873.

1. Anselmi A, Ruggieri VG, Harmouche M, et al. Appraisal of long-term outcomes of tricuspid valve replacement in the current perspective. Ann Thorac Surg, 2016, 101(3): 863-871.
2. Hwang HY, Kim KH, Kim KB, et al. Reoperations after tricuspid valve repair: re-repair versus replacement. J Thorac Dis, 2016, 8(1): 133-139.
3. Nishimura RA, Otto CM, Bonow RO, et al. 2104 AHA/ACC guideline for the management of the patients with valvular heart disease: a report of the American College of Cardiolagy/ American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 2438-2488.
4. Chikwe J, Itagaki S, Anyanwu A, et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol, 2015, 65(18): 1931-1938.
5. Cha BK, Kuh JH, Choi JB. Leaflet augmentation for treating tricuspid valve regurgitation: indications and the patch size. J Card Surg, 2015, 30(12): 903-904.
6. Said SM, Burkhart HM, Schaff HV, et al. When should a mechanical tricuspid valve replacement be considered? J Thorac Cardiovasc Surg, 2014, 148(2): 603-608.
7. Pfannmüller B, Moz M, Misfeld M, et al. Isolated tricuspid valve surgery in patients with previous cardiac surgery. J Thorac Cardiovasc Surg, 2013, 146(4): 841-847.
8. Jeganathan R, Armstrong S, Al-Alao B, et al. The risk and outcomes of reoperative tricuspid valve surgery. Ann Thorac Surg, 2013, 95(1): 119-124.
9. Herzer R, Hacje P, Javier M, et al. The long-term impact of various techniques for tricuspid repair in Ebstein’s anomaly. J Thorac Cardiovasc Surg, 2015, 150(5): 1212-1219.
10. Bevan PJ, Haydock DA, Kang N. Long-term survival after isolated tricuspid valve replacement. Heart Lung Circ, 2014, 23(8): 697-702.
11. De Meester P, Van De Bruaene A, Voigt JU, et al. Outcome and determinants of prognosis in patients undergoing isolated tricuspid valve surgery: retrospective single center analysis. Int J Cardiol, 2014, 175(2): 333-339.
12. Dillon J, Yakub MA, Nordin MN, et al. Leaflet extension in rheumatic mitral valve reconstruction. Eur J Cardiothorac Surg, 2013, 44(4): 682-689.
13. Dillon J, Yakub MA, Kong PK, et al. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: Is repair for " burnt-out” rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg, 2015, 149(3): 771-779.
14. Pettinari M, Bertrand P, Van Kerrebroeck C, et al. Mid-term results of leaflet augmentation in severe tricuspid functional tethering. Eur J Cardiothorac Surg, 2016, 50(3): 504-508.
15. Parolari A, Barili F, Pilozzi A, et al. Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review. Ann Thorac Surg, 2014, 98(6): 2255-2263.
16. 刘浩, 梅举, 汤敏, 等. 儿童心瓣膜置换术患者的临床特点及中远期随访. 中国胸心血管外科临床杂志, 2015, 22(5): 446-449.
17. Nguyen N, Sharathkumar A. Current perioperative anticoagulation practices in children with prosthetic mechanical heart valves. Congenit Heart Dis, 2015, 10(5): E210-E215.
18. Emani SM, Piekarski BL, Zurakowski D, et al. Concept of an expandable cardiac valve for surgical implantation in infants and children. J Thorac Cardiovasc Surg, 2016, 152(2): 1514-1523.
19. Xiao J, Yin L, Lin Y, et al. A 20-year study on treating childhood infective endocarditis with valve replacement in a single cardiac center in China. J Thorac Dis. 2016, 8(7): 1618-1624.
20. David TE. Aortic valve replacement in children and young adults. J Am Coll Cardiol, 2016, 67(24): 2871-2873.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Leaflet extension in reoperation after tricuspid valve repair in children

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