Tricuspid Valve Replacement vs. Repair in Severe Tricuspid Regurgitation

Jeong

et al. 2018

Circ J

Self Cite

Background: This study aimed to evaluate the early and late clinical outcomes after repeat aortic valve replacement (AVR) for subaortic pannus in patients with mechanical valves. Methods and Results:Between 2001 and 2017, 51 patients (median age, 59 years; 42 women) with prosthetic aortic stenosis (AS) caused by pannus ingrowth underwent repeat AVR because of acute malfunction of monoleaflet valve (3 patients), severe prosthetic AS (30 patients), and moderate prosthetic AS at the time of tricuspid or mitral valve surgery (18 patients). The median follow-up duration was 100 (interquartile range, 64-138) months. Double valve replacement was performed in 45 (88%) patients. Median time interval from previous operation was 161 (interquartile range, 121-194) months. The explanted mechanical AV was monoleaflet and bileaflet in 16 (31%) and 34 (67%) patients, respectively. Concomitant procedures included 16 mitral valve replacements (14 repeat) and 36 tricuspid valve surgeries (15 replacements, 21 repairs). No hospital deaths or cases of heart block occurred. Overall survival and event-free survival rates at 10 years were 88% and 51%, respectively. Late complications included recurrent prosthetic AS (4 patients), new paravalvular leakage of the mitral valve (5 patients), and severe tricuspid regurgitation (2 patients). Conclusions:Although repeat AVR for subaortic pannus had acceptable early and late survival, recurrent prosthetic AS was frequently observed during late follow-up.

Section: Advance Publication By-j-stagementioning

confidence: 98%

mentioning

confidence: 99%

Clinical Outcomes of Repeat Aortic Valve Replacement for Subaortic Pannus in Mechanical Aortic Valve

Jeong

et al. 2018

Circ J

Self Cite

“…4, 5 In our previous studies, 3,4 preoperative aortic TMPG was associated with the severity of TR. Furthermore, multivariate analysis demonstrated that postoperative aortic TMPG was an independent predictor of late TR after reoperative TVR 4 and DVR 3 .…”

Section: Discussionmentioning

confidence: 80%

Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical Mitral Valve

Sung

2018

Circ J

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Background: This study aimed to evaluate the safety and feasibility of transaortic mitral pannus removal (TMPR). Methods and Results:Between 2004 and 2016, 34 patients (median age, 57 years; 30 women) with rheumatic disease underwent pannus removal on the ventricular side of a mechanical mitral valve through the aortic valve during reoperation. The median time interval from the previous surgery was 14 years. TMPR was performed after removal of the mechanical aortic valve (n=21) or diseased native aortic valve (n=11). TMPR was performed in 2 patients through a normal aortic valve. The mitral transprosthetic mean pressure gradient (TMPG) was ≥5 mmHg in 11 patients, including 3 with prosthetic valve malfunction. Prophylactic TMPR was performed in 23 patients. There were no early deaths. Concomitant operations included 22 tricuspid valve surgeries (13 replacements, 15 repairs) and 32 aortic valve replacements (24 repeats, 8 primary). The mean gradient in patients who had mitral TMPG ≥5 mmHg was significantly decreased from 6.46±1.1 to 4.37±1.17 mmHg at discharge (P<0.001). No mechanical valve malfunction was apparent on last echocardiography. Conclusions:TMPR is a safe and effective procedure for patients with malfunction or stenosis of a mechanical mitral valve and may be considered an alternative approach in patients with pannus overgrowth in such valves.

“…In a word, Tricuspid valve replacement is undertaken when valve repair is not technically feasible or predictably durable. In many patients with secondary TR with marked right ventricular remodeling, leaflet tethering, or stenosis cases, valve replacement can be considered as a primary treatment strategy [1,26]. In contrast to the mechanical prosthetic valve, bioprosthetic valves have more advantages for the opening area and thrombus formation rate.…”

Section: Discussionmentioning

confidence: 99%

“…Tricuspid valve replacement (TVR) as one of the treatment strategies for TR, previous studies indicated that TVR is associated with worse early and long-term outcomes than tricuspid valve repair (TVP) [18][19][20][21][22][23]. Nevertheless, because of differences in baseline patient characteristics between TVR and TVP, and current indications, operation opportunity, perioperative management are different from those of 2 ~ 3 decades ago, several recently published articles showed that TVR is not related to extremely higher risk in severe TR Patients [20,21,[24][25][26]. Conventional median sternotomy has been regarded over the past decade as the standard approach for TVR for reoperations.…”

Section: Introductionmentioning

confidence: 99%

Uni-port total thoracoscopic surgery versus median sternotomy for redo tricuspid valve replacement: A retrospective study

Yan

Zheng

Chen

et al. 2020

Preprint

BACKGROUNDː This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery. METHODSː Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. 26 patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data. RESULTSː No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group was significantly longer than that in the control group (P<0.05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay and complication rates in the study group were significantly different from those in the control group (P<0.05). Throughout the follow-up period, uni-port total thoracoscopic TVR is not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation. CONCLUSIONSː Uni-port total thoracoscopic tricuspid valve replacement is safe, feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.