YANG Yanchen 1,2 , ZHONG Lishan 2 , WANG Zhenzhong 1,2 , YANG Liang 3 , KE Yingjie 4 , GUO Haijiang 2 , HE Biaochuan 2 , ZHOU Kan 2 , ZHAO Junfei 2 , HUANG Huanlei 1,2
  • 1. School of Medicine, South China University of Technology, Guangzhou, 510006, P. R. China;
  • 2. Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Guangzhou, 510100, P. R. China;
  • 3. The University of Hong Kong-Shenzhen Hospital, Shenzhen, 518048, Guangdong, P. R. China;
  • 4. Nanhai Hospital of Guangdong Provincial People's Hospital, Foshan, 528253, Guangdong, P. R. China;
HUANG Huanlei, Email: hhuanglei@hotmail.com
Left heart valve replacement; isolation; tricuspid insufficiency; tricuspid valvuloplasty; myocardial fibrosis
10.7507/1007-4848.202110061
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Objective To investigate the predictive value of right atrial myocardial fibrosis in the prognosis of isolated tricuspid regurgitation surgery after left heart valve surgery. Methods The patients who underwent tricuspid valvuloplasty by the same operator in Guangdong Provincial People's Hospital from April 2016 to August 2021 due to long-term isolated severe tricuspid regurgitation after left heart valve surgery were included in the study. According to the degree of right atrial myocardial fibrosis, the patients were divided into three groups: a mild group, a moderate group, and a severe group. The clinical data of these patients were compared and analyzed. Results A total of 75 patients were enrolled, including 16 males and 59 females with an average age of 57.0±8.4 years. There were 30 patients in the mild group, 29 patients in the moderate group and 16 patients in the severe group. In terms of the preoperative data, there were statistical differences in cardiac function grade, right atrial diameter, tricuspid incompetence area among the three groups (P<0.05). In terms of the postoperative data, there were statistical differences among the three groups in the cardiopulmonary bypass time, mechanical ventilation time, ICU monitoring time, complication rate and mortality (P<0.05). Further pairwise comparison showed that, compared with the mild group, the severe group had longer mechanical ventilation time (P=0.024), longer ICU monitoring time (P=0.003) and higher incidence of postoperative complications (P=0.024), while the moderate group had no statistical difference in all aspects (P>0.05); compared with the moderate group, the severe group had longer ICU monitoring time (P=0.021) and higher incidence of complications (P=0.006). Conclusion The early outcome of tricuspid valvuloplasty in patients with isolated tricuspid regurgitation after left heart valve surgery with severe right atrial myocardial fibrosis is worse than that in the patients with mild and moderate fibrosis, suggesting that the degree of myocardial fibrosis in the right atrium can be a predictor of the effect of tricuspid regurgitation surgery and a judgement indicator of the surgery timing.

Citation： YANG Yanchen, ZHONG Lishan, WANG Zhenzhong, YANG Liang, KE Yingjie, GUO Haijiang, HE Biaochuan, ZHOU Kan, ZHAO Junfei, HUANG Huanlei. The value of right atrial myocardial fibrosis in evaluating the prognosis of isolated tricuspid valve surgery after left heart valve surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 1008-1013. doi: 10.7507/1007-4848.202110061 Copy

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