Clinical effect of right minithoracotomy approach on tricuspid regurgitation after the left-sided valve surgery: A retrospective study of a single center_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Daokuo ¹ , WANG Baocai ² , CHENG Zhaoyun ² , ZHAO Yong ² , ZHANG Qiao ¹ , ZHANG Huakun ¹ , MA Lu ¹ , LIU Qianjin ² ,  GE Zhenwei ²

1. Department of Cardiovascular Surgery, Henan University People's Hospital, Henan Provincial People's Hospital, Zhengzhou, 450003, P. R. China;
2. Department of Cardiovascular Surgery, Heart Center of Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, 451464, P. R. China;

Corresponding author：

GE Zhenwei, Email: gezhenwei-1@163.com

Keywords：

Right minithoracotomy; tricuspid regurgitation; median sternotomy; surgery

DOI：

10.7507/1007-4848.202010014

Video：

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ObjectiveTo analyze the clinical efficacy of right minithoracotomy approach in the treatment of patients with regurgitation after left-sided valve surgery (LSVS).MethodsThe clinical data of 77 patients who suffered tricuspid regurgitation (TR) after LSVS and received surgical treatment in the Heart Center of Henan Provincial People's Hospital from 2012 to 2019 were selected. According to the operation method, the patients were divided into a right minithoracotomy group (n=32), including 13 (40.6%) males, aged 57.3±5.3 years and a median sternotomy group (n=45), including 17 (37.8%) males, aged 55.7±6.6 years. Preoperative and postoperative clinical data of the two groups were compared and analyzed.ResultsThere was no significant difference in preoperative data between the two groups. There were 24 patients of tricuspid valvuloplasty (TVP) and 8 patients of tricuspid valve replacement (TVR) in the right minithoracotomy group. There were 29 patients of TVP and 16 patients of TVR in the median sternotomy group. The operation time, postoperative hospitalization time, intubation time and ICU stay time of the right minithoracotomy group were shorter than those of the median sternotomy group (P<0.001). The operative bleeding, postoperative drainage in 24 hours, postoperative blood transfusion rate and incision poor healing of the right minithoracotomy group were significantly decreased compared with those of the median sternotomy group (P<0.05). The extracorporeal circulation time between the two groups was not significantly different (P=0.382). The postoperative complications and mortality of the righ minithoracotomy group were significantly lower than those of the median sternotomy group (P<0.05).ConclusionThe procedure of right minithoracotomy access can reduce perioperative morbidity and mortality compared with the median sternotomy, and results in satisfied clinical efficacy.

Citation： ZHENG Daokuo, WANG Baocai, CHENG Zhaoyun, ZHAO Yong, ZHANG Qiao, ZHANG Huakun, MA Lu, LIU Qianjin, GE Zhenwei. Clinical effect of right minithoracotomy approach on tricuspid regurgitation after the left-sided valve surgery: A retrospective study of a single center. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(6): 742-747. doi: 10.7507/1007-4848.202010014 Copy

1.	Izumi C, Miyake M, Takahashi S, et al. Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms. Circ J, 2011, 75(12): 2902-2907.
2.	张乐, 王崇, 张加俊, 等. 左心瓣膜置换术后重度三尖瓣关闭不全的内外科治疗比较及危险因素分析. 中国体外循环杂志, 2016, 14(2): 108-111.
3.	Pfannmueller B, Misfeld M, Haensig M, et al. Tricuspid valve repair after previous mitral valve surgery. Thorac Cardiovasc Surg, 2017, 65(8): 601-605.
4.	Chen J, Hu K, Ma W, et al. Isolated reoperation for tricuspid regurgitation after left-sided valve surgery: Technique evolution. Eur J Cardiothorac Surg, 2020, 57(1): 142-150.
5.	Kanhere V, Pendse N, Narkhede V. Results of minimally invasive approachfor rheumatic mitral valve disease. J Cardiothorac Surg, 2015, 10(S1): A240.
6.	Pope NH, Ailawadi G. Minimally invasive valve surgery. J Cardiovasc Transl Res, 2014, 7(4): 387-394.
7.	Zhai J, Wei L, Huang B, et al. Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease. Medicine, 2017, 96(24): e7193.
8.	Bernard S, Hung J. Managing tricuspid valve regurgitation: A long and winding road. Heart, 2019, 105(23): 1773-1774.
9.	Stephens EH, Borger MA. "Forgotten" valve or "enigmatic" valve? Further insights into the tricuspid valve in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2014, 148(5): 1962-1964.
10.	Rogers JH, Bolling SF. Pathophysiology and management of functional tricuspid regurgitation. Jagadeesh G, Balakumar P, Maung-U K, ed. Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Berlin: Springer-Verlag, 2015. 1201-1220.
11.	Moutakiallah Y, Aithoussa M, Atmani N, et al. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg, 2018, 13(1): 104.
12.	刘硕, 尤斌, 李平, 等. 直视微创技术在二次及多次心脏手术中的应用. 中华胸心血管外科杂志, 2017, 33(7): 420-423.
13.	Doenst T, Diab M, Sponholz C, et al. The opportunities and limitations of minimally invasive cardiac surgery. Dtsch Arztebl Int, 2017, 114(46): 777-784.
14.	Mihos CG, Pineda AM, Davila H, et al. Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach. Innovations (Phila), 2015, 10(5): 304-308.
15.	黄焕雷, 柯英杰, 杨亮, 等. 微创成形技术治疗心脏手术后重度三尖瓣关闭不全的中期疗效分析. 中华外科杂志, 2019, 57(12): 902-907.
16.	Bashore TM, Serfas JD. Isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2961-2963.
17.	Chandrashekar P, Zack C, Fender E, et al. Isolated tricuspid valve surgery: Repairversus replacement. J Am Coll Cardiol, 2017, 69(11): 1928.
18.	侯晓彤, 孟旭, 李伟, 等. 左心系统瓣膜替换术后远期三尖瓣关闭不全的手术治疗效果. 中华医学杂志, 2005, 85(47): 3362-3364.
19.	Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.

1. Izumi C, Miyake M, Takahashi S, et al. Progression of isolated tricuspid regurgitation late after left-sided valve surgery. Clinical features and mechanisms. Circ J, 2011, 75(12): 2902-2907.
2. 张乐, 王崇, 张加俊, 等. 左心瓣膜置换术后重度三尖瓣关闭不全的内外科治疗比较及危险因素分析. 中国体外循环杂志, 2016, 14(2): 108-111.
3. Pfannmueller B, Misfeld M, Haensig M, et al. Tricuspid valve repair after previous mitral valve surgery. Thorac Cardiovasc Surg, 2017, 65(8): 601-605.
4. Chen J, Hu K, Ma W, et al. Isolated reoperation for tricuspid regurgitation after left-sided valve surgery: Technique evolution. Eur J Cardiothorac Surg, 2020, 57(1): 142-150.
5. Kanhere V, Pendse N, Narkhede V. Results of minimally invasive approachfor rheumatic mitral valve disease. J Cardiothorac Surg, 2015, 10(S1): A240.
6. Pope NH, Ailawadi G. Minimally invasive valve surgery. J Cardiovasc Transl Res, 2014, 7(4): 387-394.
7. Zhai J, Wei L, Huang B, et al. Minimally invasive mitral valve replacement is a safe and effective surgery for patients with rheumatic valve disease. Medicine, 2017, 96(24): e7193.
8. Bernard S, Hung J. Managing tricuspid valve regurgitation: A long and winding road. Heart, 2019, 105(23): 1773-1774.
9. Stephens EH, Borger MA. "Forgotten" valve or "enigmatic" valve? Further insights into the tricuspid valve in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2014, 148(5): 1962-1964.
10. Rogers JH, Bolling SF. Pathophysiology and management of functional tricuspid regurgitation. Jagadeesh G, Balakumar P, Maung-U K, ed. Pathophysiology and Pharmacotherapy of Cardiovascular Disease. Berlin: Springer-Verlag, 2015. 1201-1220.
11. Moutakiallah Y, Aithoussa M, Atmani N, et al. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg, 2018, 13(1): 104.
12. 刘硕, 尤斌, 李平, 等. 直视微创技术在二次及多次心脏手术中的应用. 中华胸心血管外科杂志, 2017, 33(7): 420-423.
13. Doenst T, Diab M, Sponholz C, et al. The opportunities and limitations of minimally invasive cardiac surgery. Dtsch Arztebl Int, 2017, 114(46): 777-784.
14. Mihos CG, Pineda AM, Davila H, et al. Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach. Innovations (Phila), 2015, 10(5): 304-308.
15. 黄焕雷, 柯英杰, 杨亮, 等. 微创成形技术治疗心脏手术后重度三尖瓣关闭不全的中期疗效分析. 中华外科杂志, 2019, 57(12): 902-907.
16. Bashore TM, Serfas JD. Isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2961-2963.
17. Chandrashekar P, Zack C, Fender E, et al. Isolated tricuspid valve surgery: Repairversus replacement. J Am Coll Cardiol, 2017, 69(11): 1928.
18. 侯晓彤, 孟旭, 李伟, 等. 左心系统瓣膜替换术后远期三尖瓣关闭不全的手术治疗效果. 中华医学杂志, 2005, 85(47): 3362-3364.
19. Färber G, Tkebuchava S, Dawson RS, et al. Minimally invasive, isolated tricuspid valve redo surgery: A safety and outcome analysis. Thorac Cardiovasc Surg, 2018, 66(7): 564-571.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical effect of right minithoracotomy approach on tricuspid regurgitation after the left-sided valve surgery: A retrospective study of a single center

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