SURGICAL TREATMENT OF TRICUSPID VALVE DYSFUNCTION AFTER TOTAL CORRECTION OF CONGENITAL HEART DISEASE
Objective. To study the morphological changes of tricuspid valve (TV) and biological prosthesis in the position of TV, to determine the risk factors of insufficiency and to present an analysis of the results of repeated operations in TV in patients after previously performed complete correction of congenital heart defect (CHD). Material and methods. From January 2000 to December 2015 we conducted 86 operations on TV after earlier performed complete correction of congenital heart defects. The mean age of the patients was 24.9 ± 14.2 years (range 3 to 65). Among them, 39 (45.3%) were female and 47 (54,7%) were male. Functional and organic changes of TV were indications for reconstructive operations. Reprosthesis was performed in 24 (28%) patients. In all cases the preoperative echocardiography registered 2-4 degree of regurgitation. Оригинальная статья Results. Plasty of TV was performed in 30 (34.9%) patients, of which in 2 cases it was repeated. Prosthetics of TV was carried out in 56 patients (65.1%), and in 24 cases it was repeated. In 12 patients redo prosthetics was performed 3 times. In the early postoperative period, in 23 patients (26.7%) the following non-lethal complications were observed: the syndrome of low cardiac output (9 cases), rhythm disturbances requiring pacemaker implantation (9 cases), stroke (2 cases), spontaneous pneumothorax (2 cases), and postoperative bleeding (1 case). Overall survival after 5, 10 and 15 years was 91, 86 and 81%, respectively. Conclusion. Surgical treatment of tricuspid insufficiency after complete correction of CHD should be performed prior to the development of severe heart failure, thus reducing the percentage of right ventricle dysfunction. To date the question remains, in what cases replasty of TV should be performed, and when to resort to prosthetics. The development of the plan of future operations and the choice of an optimal surgical approach will contribute to reducing the number of complications and the risk of repeated interventions.
About the authorsPodzolkov V.P.
Saidov Maksud Arifovich
Stark J., Pacifico A. (Eds.) Reoperations in cardiac surgery. London, New York: Springer-Verlag; 1989.
Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Cheban V.N. Reoperations after correction of congenital heart defects. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva; 2013 (in Russ.).
Said S.M., Dearani J.A., Burkhart H.M., Connolly H.M., Eidem B., Stensrud P.E., Schaff H.V. Management of tricuspid regurgitation in congenital heart disease: is survival better with valve repair? J. Thorac. Cardiovasc. Surg. 2014; 147 (1): 412-7. DOI: 10.1016/j.jtcvs.2013.08.034
Stark J.F., de Leval M.R., Tsang V.T. (Eds.) Surgery for congenital heart defects. 3rd ed. Chichester, UK: John Wiley & Sons; 2006. DOI: 10.1002/0470093188
Bockeria L.A., Podzolkov V.P., Sabirov B.N. Ebstein's anomaly. Moscow: Nauchnyy Tsentr Serdechno-Sosudistoy Khirurgii imeni A.N. Bakuleva; 2005 (in Russ.).
Lewis M.J., Ginns J.N., Ye S., Chai P., Quaegebeur J.M., Bacha E., Rosenbaum M.S. Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes. J. Thorac. Cardiovasc. Surg. 2016; 151 (2): 460-5. DOI: 10.1016/j.jtcvs.2015.09.028
Chernogrivov I.E. Surgical treatment of iatrogenic and post-traumatic insufficiency of the tricuspid valve. Diss.. cand. med. sci. Moscow; 2011 (in Russ.).
Gupta A., Vijay Grover V., Gupta V.K. Congenital tricuspid regurgitation: review and a proposed new classification. Cardiol. Young. 2011; 21 (2): 121-9. DOI: 10.1017/S104795111000168X
Dalrymple-Hay M.J., Leung Y., Ohri S.K., Haw M.P., Ross J.K., Livesey S.A., Monro J.L. Tricuspid valve replacement: bioprostheses are preferable. J. Heart Valve Dis. 1999; 8 (6): 644-8.
Dearani J.A., Said S.M., Burkhart H.M., Pike R.B., O'Leary P.W., Cetta F. Strategies for tricuspid re-repair in Ebstein malformation using the cone technique. Ann. Thorac. Surg. 2013; 96 (1): 202-10. DOI: 10.1016/j.athoracsur.2013.02.067
Dzemeshkevich S.L., Stevenson L.W. Diseases of mitral valve. Moscow: GEOTAR-Media; 2000 (in Russ.).
Hwang H.Y., Kim K.H., Kim K.B., Ahn H. Reoperations after tricuspid valve repair: re-repair versus replacement. J. Thorac. Dis. 2016; 8 (1): 133-139. DOI: 10.3978/j.issn.2072-1439.2016. 01.43
Dawood M.Y., Cheema F.H., Ghoreishi M., Foster N.W., Villanueva R.M., Salenger R. Contemporary outcomes of operations for tricuspid valve infective endocarditis. Ann. Thorac. Surg. 2015; 99 (2): 539-46. DOI: 10.1016/j.athoracsur.2014.08.069
Shevchenko Yu.L., Khubulava Yu.L., Shikhverdiev N.N. Infective endocarditis as a surgical problem in Russia. Vestnik Khirurgii imeni I.I. Grekova (Grekov Bulletin of Surgery, Russian journal). 2003; 2: 12-7 (in Russ.).
De Bonis M., Lapenna E., La Canna G., Grimaldi A., Maisano F., Torracca L. et al. A novel technique for correction of severe tricuspid valve regurgitation due to complex lesions. Eur. J. Cardiothorac. Surg. 2004; 25 (5): 760-5. DOI: 10.1016/j.ejcts.2004.01.051
Duran C.M. Tricuspid valve surgery revisited. J. Card. Surg. 1994; 9 (2 Suppl.): 242-7.
Iscan Z.H., Vural K.M., Bahar I., Mavioglu L., Saritas A. What to expect after tricuspid valve replacement? Long-term results. Eur. J. Cardiothorac. Surg. 2007; 32 (2): 296-300. DOI: 10.1016/j.ejcts. 2007.05.003
Said S.M., Burkhart H.M., Schaff H.V., Johnson J.N., Connolly H.M., Dearani J.A. When should a mechanical tricuspid valve replacement be considered? J. Thorac. Cardiovasc. Surg. 2014; 148 (2): 603-8. DOI: 10.1016/j.jtcvs.2013.09.043
Burri M., Vogt M.O., Hörer J., Cleuziou J., Kasnar-Samprec J., Kühn A. et al. Durability of bioprostheses for the tricuspid valve in patients with congenital heart disease. Eur. J. Cardiothorac. Surg. 2016; 50 (5): 988-93. DOI: 10.1093/ejcts/ezw094
- Refbacks are not listed
Контент доступен под лицензией Creative Commons Attribution 3.0 License.