Surgical treatment of severe tricuspid regurgitation late left-sided heart valve replacement in patients with rheumatic valve disease

Abstract

Objective To summarize the surgical results of severe trcuspid regurgitation(TR)late afte left-sided heart valve replacement in patients with rheumatic valve disease,and to investigate the possible pathogenesis of late TR,surgical indictation and metnods.Methodd Thirty-seven patients developed severe TR 5-16 years later after rheumatic mitral or/and aortic valve replacement.All of them had various degree of right heart failure.The mean left ventricular ejection fraction(LVEF)was 0.52.±0.05. and the mean pulmonary pressure was(37.6±7.8)mmHg.Tricuspid valve repacement(TVR)was performed in 25 cases,modified DeVega annuloplastyin 4,and ring ammuloplasty in 8 throrgh right anterio-lateral thoracotomy or middle sternotomy.Rsesults Four patients died postoperatively with hospital mortality of 10.8%.Another 4 patients died(right heart failure in 3 and ventricular arrhythmian in 1)during 2 months to 10 years follow-up period.The clinical maniifestations were significantly improvd in al survivores.Conchusion The mechanisms of late sever TR wered closely correlated with sustainedd pulmonary phypertension,rheumatic tricuspid lesion,ignored tricuspid annular dilation during the first procedure,and incorrect methods of annuloplasty or uncompetence of the procedure.The surgical indication for late severe TR is that the left ventrcular must be in the normal scope,right ventrcular function is not severely damaged,and there is no severe pulmonary hypertension.Early surgical intervention is encouraged in order to obtain better surgical outcomes.TVR with the preservation of total tricuspid structures may improve right heart function and surgical outcomes.Potoperative long-term outcomes mainly depend on right ventricular function. Key words: Pdauamatic heart disease; Tricuspid valve insufficiency; Heart valve prosthesis implantation