Objective To evaluate the preliminary effect of tricuspid annuloplasty for patients with dilated tricuspidannulus and left-sided heart valve surgery by employing combined bicuspidization and modified Kay annuloplasty. Methods?Combined bicuspidization and modified Kay annuloplasty were performed in 158 patients with dilated tricuspidannulus (tricuspid annulus diameter/body surface area≥21 mm/m2) and left-sided heart valve surgery in West China Hospital
between January 2010 and May 2011. There were 27 male and 131 female patients whose age ranged from 17 to 74 (45.9±10.4) years. A total of 92 patients had atrial fibrillation and 66 patients were in sinus rhythm. The severity of tricuspid regurgitation(TR)was graded 0 through 5 as determined by echocardiography.?Results?All the patients recovered from surgery and were discharged from hospital. The average cardiopulmonary bypass time was 100.8±30.5 (range, 54 to 273) min, and the average aortic cross clamping time was 64.5±22.0(range, 25 to 162)min. The average lowest esophageal temperature during aortic cross clamping was 28.5±1.1(range, 26.3 to 34.1)?℃. The average postoperative follow-up was 11.0±5.0 (range, 3 to 19) months. The postoperative TR severity was significantly lower than preoperative TR severity (2.2±1.3 versus 0.4±0.8, P<0.05). The postoperative right atrium diameter, right ventricle diameter and left atrium diameter were significantly lower than preoperative measurements (56.5±11.1 mm versus 47.5±8.9 mm, P<0.05;22.4±4.4 mm versus 20.1±3.3 mm, P<0.05;62.8±20.1 mm versus 51.9±14.1 mm, P<0.05). During follow-up, 5 patients had moderate or severe TR (3.2%, 5/158, moderate in 4 patients, moderate to severe in 1 patient). There was no significant difference between preoperative and postoperative left ventricle ejection fraction (60.4%±7.9% vervsus 59.6%±8.2%, P>0.05).?Conclusion?It is reasonable to perform tricuspid annuloplasty for patients with dilated tricuspid annulus and left-sided heart valve surgery according to their index of tricuspid annulus diameter/body surface area (≥21 mm/m2). To prevent postoperative residue or progression of TR in patients with dilated tricuspid annulus,it is effective to employ combined bicuspidization and modified Kay annuloplasty.
Citation: XIAO Xijun,JIANG Lu,LI Yongbo,TANG Hong,ZHOU Wenxia,ZHU Wei.. Preliminary Effect of Tricuspid Annuloplasty for Patients with Dilated Tricuspid Annulus and Left-sided Heart Valve Surgery by Employing Combined Bicuspidization and Modified Kay Annuloplasty. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 516-519. doi: Copy