改良经右胸三尖瓣置换术治疗左心瓣膜置换术后孤立性三尖瓣反流

Technical modification of tricuspid valve replacement through right thoracotomy in treating Isolated Tricuspid Regurgitation After Left-Sided Valve Surgery

目的:介绍采用改良的经右胸三尖瓣置换术治疗左心瓣膜置换术后孤立性三尖瓣反流的经验。方法:在传统经右胸三尖瓣置换术的基础上,进一步采用带气囊气管导管作为上下腔静脉引流管,避免解剖右心房和心包之间的粘连,将此技术用于13例患者,收集患者临床资料,统计其一般资料和术中、术后资料。结果:所有患者均成功置换三尖瓣;平均住院时间(21.2±8.6)d,手术时间(4.3±1.4)h,体外循环时间(1.1±0.4)h,ICU滞留时间(4.1±2.7)d,呼吸机使用时间(69±58)h,术后24 h引流量(719±443)m L,输血(812±619)m L;二次开胸2例,肾替代治疗2例,人工肝1例;死亡1例,死于肝功能衰竭。结论:改良的二次三尖瓣置换术简单易行,具有一定的优势。

Objective To introduce our experience of secondary tricuspid valve replacement trough right thoracotomy in treating isolated tricuspid regurgitation after left-sided valve surgery using the techniques improved by our center. Methods Based on the traditional tricuspid valve replacement trough right thoracotomy, two tracheal catheters with air bag as vena cava drainage tubes to avoid separate the adhesion between the pericardial and the right atrium. 13 patients （Operated in Renmin hospital of Wuhan University between 2011.1 and 2016.7） were treated using this technique. Results Tricuspid valve prosthesis were successfully implanted into each of the 13 patients. The mean hospitalization day was （21.2± 8.6） d. The mean operation time was （4.3 ± 1.4） h and the mean cardio-pulmonary bypass time was （1.1 ± 0.4） h. The mean ICU stay days were （4.1 ± 2.7） d. The mechanical respiration time was （69 ± 58） h. The postoperative bleeding volume was （719 ± 443） mL and the total blood transfusion volume was （812 ± 619） mL. Two patients experienced re-exploration for hemorrhage. Two patients experienced dialysis and one patient experienced plasmapheresis. One patients died post-operatively. Conclusions our improved tricuspid valve replacement procedure trough right thoracotomy is easy and effective. It worth promoting in treating Isolated Tricuspid Regurgitation After Eeft-Sided Valve Surgery.