Feasibility of simultaneous thoracoscopic mitral and tricuspid valvuloplasty in treatment of degenerative heart disease

Abstract

Objective To retrospectively summarize the feasibility of mitral valvuloplasty (MVP) and tricuspid valvuloplasty (TVP) performed under Video-assisted right thoracic small incision in patients with degenerative heart valve disease in our center at the same time. Methods A total of 118 patients with degenerative heart valve disease from March 2016 to March 2018 were retrospectively summarized. They had mitral valve stenosis or insufficiency, secondary right ventricular dilatation or pulmonary hypertension, moderate and severe functional tricuspid regurgitation, diastolic tricuspid annular diameter/body surface area>21 mm/m2 measured by ultrasonography, or corresponding clinical symptoms of mitral and tricuspid valve lesions, and the indications of MVP and TVP were evaluated at the same time. Among them, 68 cases were treated with traditional median thoracotomy in control group, and other 50 cases were treated with Video-assisted right thoracic small incision in observation group. Then to compare surgical indicators including success rate, perioperative complications, operation time, cardiopulmonary bypass time, ventilator time, ICU stay time, thoracic drainage volume, blood transfusion volume and stay-in hospital days after operation; cardiac function indicators including left ventricular ejection fraction (LVEF), left ventricular diameter, right ventricular diameter, pulmonary artery pressure, residual mitral and tricuspid regurgitation and cardiac function classification; mid-term complications after 28.9 months of median follow-up. Results There was no difference of success rate in the two groups (P>0.05), but perioperative complications rate in observation group was less than control group, ICU stay time and stay-in hospital days were shorter, thoracic drainage volume and blood transfusion volume were lower (χ2=4.230, t=7.658, 4.659, P 0.05), but LVEF, right ventricular diameter, pulmonary artery pressure, cardiac function grade, left ventricular diameter, residual mitral and tricuspid regurgitation after operation in the two groups were all no differences (t=0.765, P>0.05). Furtherly, there was no difference of mid-term complications in the two groups (P>0.05). Conclusion It can bring better safety of simultaneous MVP and TVP with Video-assisted right thoracic small incision for degenerative valvular heart disease, which can achieve the same clinical effect as traditional surgical methods. Total thoracoscopy may benefit more in alleviating surgical trauma, promoting early recovery after operation, and have the same effect in cardiac structure and function changes and mid-term follow-up prognosis. Key words: Video-assisted; Mitral valvuloplasty; Tricuspid valvuloplasty; Degenerative heart valve disease