Isolated “on-pump” tricuspid valve repair through right-sided anterolateral thoracotomy by modified femoral-monocaval cannulation in patients with repeated heart intervention – a safe and effective surgical alternative
DOI:
https://doi.org/10.14739/mmt.2024.3.303524Keywords:
single-center study, tricuspid insufficiency, reoperation, anterolateral thoracotomy, isolated annuloplication, aortic clamping, working heart strategy, cardioplegia, cannulation, control echocardiographyAbstract
Tricuspid valve dysfunction has always been considered less clinically important than left heart valve disease. Disruption of the tricuspid valve can lead to cardiac dysfunction, causing severe and irreversible complications in patients if not treated in time. Reoperations for tricuspid valve insufficiency are surgical procedures associated with particularly high peri- and postoperative risk. The optimal timing and strategies for surgical intervention in isolated tricuspid valve insufficiency remain controversial.
Aim. Improving the immediate and long-term outcomes of patients with a cardiac surgical profile by evaluating the efficacy and safety of isolated tricuspid valve repair on the working heart by right anterolateral thoracotomy with reintervention.
Materials and methods. A single-center retrospective observational study of the clinical data of 12 patients who underwent tricuspid valve monosurgery between January 2022 and March 2024 was conducted. We evaluated the results of surgery in patients with isolated tricuspid valve annuloplasty on a working heart through a right anterolateral thoracotomy. Planned surgery was performed in 100 % (n = 12) of patients. The average age of the patients was 68.8 ± 2.2 years. Patients were divided by sex as follows: women – 75 % (n = 9), men – 25 % (n = 3). We collected demographic data of the patients, results of echocardiography, surgical intervention, hospitalization, and EuroSCORE was calculated based on patient medical records.
Results. The degree of postoperative regurgitation of the tricuspid valve according to the results of control echocardiography significantly decreased compared to the degree of insufficiency before surgery. The level of in-hospital mortality in the first 30 days after surgery in the studied group was 8.33 % (n = 1) of cases. The average duration of parallel artificial circulation was 63.3 ± 8.6 min, surgical intervention lasted 271.67 ± 22.20 min, the average duration of postoperative inotropic support was 0.8 ± 0.2 days, transfusion of blood components was required in 8.33 % (n = 1) of cases, stay in the intensive care unit after surgery was 1.0 ± 0.9 days, the total duration of hospitalization was 4.30 ± 1.72 days. Indicators of renal failure, EuroSCORE, episodes of cardiac arrhythmias, and other postoperative complications were significantly lower than with standard surgical techniques described in the current scientific literature.
Conclusions. Isolated tricuspid valve repair on the working heart through right anterolateral thoracotomy is a safe and effective surgical alternative in patients with reoperation. The use of right-sided anterolateral thoracotomy during repeated cardiac surgery allows preserving the integrity of the bone frame, avoiding technically difficult cardioplegia and aortic clamping, preventing damage to the main vessels and coronary arteries when mobilizing certain parts of the heart, and heart failure. Carrying out tricuspid valve plastic surgery on a working heart allows to achieve a good clinical result in patients with isolated tricuspid insufficiency at careful selection of the responders for the proposed technique with satisfactory terms of stay in the intensive care unit and in the hospital, the absence of ischemic and/or reperfusion damage to the heart, and a quick return to normal life activities. Indications for isolated surgery on the tricuspid valve should be based on reliable echocardiographic parameters of the right heart function.
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