Right Minithoracotomy versus Conventional Median Sternotomy for Late Tricuspid Regurgitation after Cardiac Surgery: A Case Control Study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei , YUANYuan , YINHang , DINGFang-bao , BAOChun-rong , MANan , HUANGJian-bing , ZHANGJun-wen ,  MEIJu

Department of Cardiothoracic Surgery Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding?author：

MEIJu, Email: ju_mei63@126.com

Keywords：

Minimally invasive surgery; Tricuspid regurgitation; Repeated

DOI：

10.7507/1007-4848.20150239

Video：

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Objective To compare the outcomes of repeated tricuspid valve surgery for patients with late severe tricuspid regurgitation (TR) after cardiac surgery through right anterior minithoracotomy and conventional median sternotomy approaches. Methods Between June 2002 and June 2013, 89 patients with late severe tricuspid regurgitation after cardiac surgery underwent repeated tricuspid valve surgery through right anterior minithoracotomy in our hospital. The patients were divided into two groups. Fifty one patients were in a minimally invasive group with 28 males and 23 females at age of 46.59±11.53 years. Thirty eight patients were in a conventional median sternotomy (conventional group) with 15 males and 23 females at age of 50.42±9.30 years. The outcomes of the two groups were compared. Results There was no statisitcal difference in preoperative clinical data between two groups. All patients successfully underwent repeated tricuspid valve surgery. Tricuspid valve replacement (TVR) was performed in 68 patients (38 patients vs. 30 patients), and tricuspid valvuloplasty (TVP) was performed in 21 patients (13 patients vs. 8 patients). Compared with the conventional group, operation time, time of establishing cardiopulmonary bypass and postoperative in-hospital time were significantly shorter in the minimally invasive group (P<0.001). The postoperative drainage was significantly reduced in the minimally invasive group compared with the value of the conventional group (P<0.001). Three patients died in the early postoperative period (1 patient vs. 2 patients). In the conventional group, one patient needed re-exploration for bleeding and 2 patients had wound infection. At discharge, transthoracic echocardiography showed that all patients had no or mild TR and no paravalvular leakage occurred. During the follow-up (12-144 months), 4 patients died (2 patients vs. 2 patients). In the minimally invasive group, one patient underwent repeated TVR due to severe TR associated with infective endocarditis, and another patient had moderate TR. In the conventional group, one patient underwent repeated TVR due to mechanical valve thrombosis. Conclusion Right anterior minithoracotomy is safe, effective and reliable for patients with late severe TR after cardiac surgery. It has the similar effect of the correction of valvular lesions with conventional median sternotomy, but right anterior minithoracotomy has more benefits, including more, minimally invasive, less blood loss, shorter operation time and faster recover.

Citation： JIANGZhao-lei, YUANYuan, YINHang, DINGFang-bao, BAOChun-rong, MANan, HUANGJian-bing, ZHANGJun-wen, MEIJu. Right Minithoracotomy versus Conventional Median Sternotomy for Late Tricuspid Regurgitation after Cardiac Surgery: A Case Control Study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2015, 22(10): 961-965. doi: 10.7507/1007-4848.20150239 Copy

1.	[Pfannmüller B,Moz M,Misfeld M,et al.Isolated tricuspid valve surgery in patients with previous cardiac surgery.J Thorac Cardiovasc Surg,2013,146(4):841-847.
2.	Song H,Kim MJ,Chung CH,et al.Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.Heart,2009,95(11):931-936.
3.	肖學鈞,何競功,盧聰,等.左心瓣膜置換術后遠期三尖瓣關閉不全的外科治療.中國胸心血管外科臨床雜志,2003,10(4):298-299.
4.	Raikhelkar J,Lin HM,Neckman D,et al.Isolated Tricuspid Valve Surgery:Predictors of Adverse Outcome and Survival.Heart Lung Circ,2013,22(3):211-220.
5.	Botta L,Cannata A,Fratto P,et al.The role of the minimally invasive beating heart technique in reoperative valve surgery.J Card Surg,2012,27(1):24-28.
6.	Lee TC,Desai B,Glower DD.Results of 141 consecutive minimally invasive tricuspid valve operations:an 11-year experience.Ann Thorac Surg,2009,88(6):1845-1850.
7.	Jeong DS,Park PW,Mwambu TP,et al.Tricuspid reoperation after left-sided rheumatic valve operations.Ann Thorac Surg,2013,95(6):2007-2013.
8.	Li ZX,Guo ZP,Liu XC,et al.Surgical treatment of tricuspid regurgitation after mitral valve surgery:a retrospective study in China.J Cardiothorac Surg,2012,7:30.
9.	Anyanwu AC,Chikwe J,Adams DH.Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery.Curr Cardiol Rep,2008,10(2):110-117.
10.	Fukunaga N,Okada Y,Konishi Y,et al.Impact of tricuspid regurgitation after redo valvular surgery on survival in patients with previous mitral valvereplacement.J Thorac Cardiovasc Surg,2014.pii:S0022-5223(14)00006-3.doi:10.1016/j.jtcvs.2013.08.089.
11.	Izumi C,Iga K,Konishi T,et al.Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease.J Heart Valve Dis,2002,11(3):353-356.
12.	Reyfus GD,Corbi P J,Chan KM,et al.Secondary tricuspid regurgitation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg,2005,79(1):127-132.
13.	姜兆磊,朱家全,梅舉,等.腔靜脈內阻斷技術在單純性三尖瓣微創手術中的應用.中國心血管病研究,2013,11(8):564-567.
14.	Said SM,Dearani JA,Burkhart HM,et al.Management of tricuspid regurgitation in congenital heart disease:is survival better with valve repair?J Thorac Cardiovasc Surg,2014,147(1):412-417.
15.	Cheng JW,Russell H,Stewart RD,et al.The role of tricuspid valve surgery in the late management of tetralogy of Fallot:collective review.World J Pediatr Congenit Heart Surg,2012,3(4):492-498.
16.	Ricci D,Boffini M,Barbero C,et al.Minimally invasive tricuspid valve surgery in patients at high risk.J Thorac Cardiovasc Surg,2014,147(3):996-1001.
17.	Jiang Z,Mei J,Ding F,et al.Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy.Heart Lung Circ,2014,23(2):186-189.
18.	姜兆磊,梅舉,吳淑彬,等.經食道超聲心動圖在運用腔靜脈內阻斷技術實施微創三尖瓣再次手術中的應用.上海交通大學學報(醫學版),2014,34(2):161-164.
19.	梅舉,張寶仁,郝家驊,等.二尖瓣置換術后遠期功能性三尖瓣關閉不全的外科治療.中華胸心血管外科雜志,2001,17(1):16-18.
20.	陳和忠,張寶仁,鄒良健,等.風濕性心臟病人工瓣膜置換術后再發重度三尖瓣關閉不全的外科治療.中國胸心血管外科臨床雜志,2002,9(3):219-220.
21.	Raja SG,Dreyfus GD.Surgery for functional tricuspid regurgitation:current techniques,outcomes and emerging concepts.Expert Rev Cardiovasc Ther,2009,7(1):73-84.

1. [Pfannmüller B,Moz M,Misfeld M,et al.Isolated tricuspid valve surgery in patients with previous cardiac surgery.J Thorac Cardiovasc Surg,2013,146(4):841-847.
2. Song H,Kim MJ,Chung CH,et al.Factors associated with development of late significant tricuspid regurgitation after successful left-sided valve surgery.Heart,2009,95(11):931-936.
3. 肖學鈞,何競功,盧聰,等.左心瓣膜置換術后遠期三尖瓣關閉不全的外科治療.中國胸心血管外科臨床雜志,2003,10(4):298-299.
4. Raikhelkar J,Lin HM,Neckman D,et al.Isolated Tricuspid Valve Surgery:Predictors of Adverse Outcome and Survival.Heart Lung Circ,2013,22(3):211-220.
5. Botta L,Cannata A,Fratto P,et al.The role of the minimally invasive beating heart technique in reoperative valve surgery.J Card Surg,2012,27(1):24-28.
6. Lee TC,Desai B,Glower DD.Results of 141 consecutive minimally invasive tricuspid valve operations:an 11-year experience.Ann Thorac Surg,2009,88(6):1845-1850.
7. Jeong DS,Park PW,Mwambu TP,et al.Tricuspid reoperation after left-sided rheumatic valve operations.Ann Thorac Surg,2013,95(6):2007-2013.
8. Li ZX,Guo ZP,Liu XC,et al.Surgical treatment of tricuspid regurgitation after mitral valve surgery:a retrospective study in China.J Cardiothorac Surg,2012,7:30.
9. Anyanwu AC,Chikwe J,Adams DH.Tricuspid valve repair for treatment and prevention of secondary tricuspid regurgitation in patients undergoing mitral valve surgery.Curr Cardiol Rep,2008,10(2):110-117.
10. Fukunaga N,Okada Y,Konishi Y,et al.Impact of tricuspid regurgitation after redo valvular surgery on survival in patients with previous mitral valvereplacement.J Thorac Cardiovasc Surg,2014.pii:S0022-5223(14)00006-3.doi:10.1016/j.jtcvs.2013.08.089.
11. Izumi C,Iga K,Konishi T,et al.Progression of isolated tricuspid regurgitation late after mitral valve surgery for rheumatic mitral valve disease.J Heart Valve Dis,2002,11(3):353-356.
12. Reyfus GD,Corbi P J,Chan KM,et al.Secondary tricuspid regurgitation or dilatation:which should be the criteria for surgical repair? Ann Thorac Surg,2005,79(1):127-132.
13. 姜兆磊,朱家全,梅舉,等.腔靜脈內阻斷技術在單純性三尖瓣微創手術中的應用.中國心血管病研究,2013,11(8):564-567.
14. Said SM,Dearani JA,Burkhart HM,et al.Management of tricuspid regurgitation in congenital heart disease:is survival better with valve repair?J Thorac Cardiovasc Surg,2014,147(1):412-417.
15. Cheng JW,Russell H,Stewart RD,et al.The role of tricuspid valve surgery in the late management of tetralogy of Fallot:collective review.World J Pediatr Congenit Heart Surg,2012,3(4):492-498.
16. Ricci D,Boffini M,Barbero C,et al.Minimally invasive tricuspid valve surgery in patients at high risk.J Thorac Cardiovasc Surg,2014,147(3):996-1001.
17. Jiang Z,Mei J,Ding F,et al.Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy.Heart Lung Circ,2014,23(2):186-189.
18. 姜兆磊,梅舉,吳淑彬,等.經食道超聲心動圖在運用腔靜脈內阻斷技術實施微創三尖瓣再次手術中的應用.上海交通大學學報(醫學版),2014,34(2):161-164.
19. 梅舉,張寶仁,郝家驊,等.二尖瓣置換術后遠期功能性三尖瓣關閉不全的外科治療.中華胸心血管外科雜志,2001,17(1):16-18.
20. 陳和忠,張寶仁,鄒良健,等.風濕性心臟病人工瓣膜置換術后再發重度三尖瓣關閉不全的外科治療.中國胸心血管外科臨床雜志,2002,9(3):219-220.
21. Raja SG,Dreyfus GD.Surgery for functional tricuspid regurgitation:current techniques,outcomes and emerging concepts.Expert Rev Cardiovasc Ther,2009,7(1):73-84.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Right Minithoracotomy versus Conventional Median Sternotomy for Late Tricuspid Regurgitation after Cardiac Surgery: A Case Control Study

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