Objective To evaluate the preliminary effect of tricuspid annuloplasty for patients with dilated tricuspidannulus and left-sided heart valve surgery by employing combined bicuspidization and modified Kay annuloplasty. Methods?Combined bicuspidization and modified Kay annuloplasty were performed in 158 patients with dilated tricuspidannulus （tricuspid annulus diameter/body surface area≥21 mm/m2） and left-sided heart valve surgery in West China Hospitalbetween January 2010 and May 2011. There were 27 male and 131 female patients whose age ranged from 17 to 74 （45.9±10.4） years. A total of 92 patients had atrial fibrillation and 66 patients were in sinus rhythm. The severity of tricuspid regurgitation（TR）was graded 0 through 5 as determined by echocardiography.?Results?All the patients recovered from surgery and were discharged from hospital. The average cardiopulmonary bypass time was 100.8±30.5 （range, 54 to 273） min, and the average aortic cross clamping time was 64.5±22.0（range, 25 to 162）min. The average lowest esophageal temperature during aortic cross clamping was 28.5±1.1（range, 26.3 to 34.1）?℃. The average postoperative follow-up was 11.0±5.0 （range, 3 to 19） months. The postoperative TR severity was significantly lower than preoperative TR severity （2.2±1.3 versus 0.4±0.8， P＜0.05）. The postoperative right atrium diameter, right ventricle diameter and left atrium diameter were significantly lower than preoperative measurements （56.5±11.1 mm versus 47.5±8.9 mm， P＜0.05；22.4±4.4 mm versus 20.1±3.3 mm， P＜0.05；62.8±20.1 mm versus 51.9±14.1 mm， P＜0.05）. During follow-up, 5 patients had moderate or severe TR （3.2%， 5/158, moderate in 4 patients, moderate to severe in 1 patient）. There was no significant difference between preoperative and postoperative left ventricle ejection fraction （60.4%±7.9% vervsus 59.6%±8.2%， P＞0.05）.?Conclusion?It is reasonable to perform tricuspid annuloplasty for patients with dilated tricuspid annulus and left-sided heart valve surgery according to their index of tricuspid annulus diameter/body surface area （≥21 mm/m2）. To prevent postoperative residue or progression of TR in patients with dilated tricuspid annulus,it is effective to employ combined bicuspidization and modified Kay annuloplasty.
Objective To compare and evaluate the short-term outcomes of 3 different tricuspid valve plasty for functional tricuspid regurgitation (TR) in patients with rheumatic heart disease. Methods Between October 2010 and June 2011, 148 patients with rheumatic heart disease undergoing left heart valve replacement and tricuspid valve plasty for functional TR were enrolled in the study. There were 32 males and 116 females with an average age of 47.5 years (range, 15-66 years). The patients were divided into 3 groups depending on tricuspid valve plasty: Cosgrove-Edwards annuloplasty ring group (annuloplasty ring group, 58 cases), Kay annuloplasty group (Kay group, 61 cases), and DeVega annuloplasty group (DeVaga group, 29 cases). There was no significant difference in general data among groups (P gt; 0.05), except more severe TR degree, higher atrial fibrillation, and higher radiofrequency ablation in annuloplasty ring group (P lt; 0.05). Perioperative data were recorded. The heart function was evaluated according to the standard of New York Heart Association (NYHA). Echocardiography (ECG) was used to record the TR class during perioperative period and follow-up. Results After operation, 1 case in Kay group and 1 case in annuloplasty ring group were dead because of low cardiac output syndrome. Pneumonia happened in 2 cases of Kay group and in 1 case of annuloplasty ring group; re-operation was performed in 1 case of annuloplasty ring group because of sternal dehiscence. There was no significant difference in perioperative complication among 3 groups (P=0.840). The TR degree was significantly improved at discharge when compared with preoperative degree in 3 groups (P lt; 0.001). A total of 146 patients were followed up 6-12 months (mean, 7.3 months). The NYHA grade of 3 groups at last follow-up was improved when compared with preoperative grade (P lt; 0.001), but no significant difference among 3 groups (χ2=0.120, P=0.942). The TR degree at last follow-up was all improved in 3 groups when compared with preoperative degree (P lt; 0.001); the improved efficiency showed significant difference among 3 groups (χ2=26.827, P=0.000), it was significantly better in annuloplasty ring group than in the other 2 groups (P lt; 0.001), but no significant difference between DeVega group and Kay group (Z=1.467, P=0.142). Conclusion The early improved efficiency of TR after Cosgrove-Edwards annuloplasty is superior to that of Kay annuloplasty and DeVega annuloplasty.