This study retrospectively analyzed 56 patients with tricuspid valve endocarditis who were surgically treated in our hospital from January 2010 to June 2020, including 23 patients in the TVP group and 33 patients in the TVR group. All diagnoses were in accordance with the revised Duke criteria, and preoperative echocardiograms showed the formation of tricuspid valve vegetation with moderate or severe tricuspid regurgitation.
There was no significant difference in sex, age, course of fever, preoperative cardiac function, preoperative complications and underlying diseases between the two groups (P > 0.05).In TVP group, 3 cases had previous cardiac surgery, 4 cases had cardiac pacemaker implantation, 12 cases were complicated with congenital heart malformation, 4 cases were complicated with left ventricular valvular disease (4 cases were complicated with left endocarditis).In TVR group, there were 3 cases of previous cardiac surgery, 13 cases of congenital heart malformation and 10 cases of left ventricular valvular disease (5 cases with left endocarditis).(table.1)
All patients exhibited signs of acute infection, such as high fever and leukocytosis. Blood cultures revealed Staphylococcus aureus (n=8), Staphylococcus epidermidis (n=3), Enterococcus faecalis(n=3), Streptococcus bovis (n=10), Acinetobacter baumannii (n=3). In the remaining patients no bacterial growth was detected, which was most likely due to previous antibiotic therapy.
All operations were performed under general anesthesia, the sternum was cut in the middle, and cardiopulmonary bypass was established through the ascending aorta and the superior and inferior vena cava.After cardiopulmonary bypass, the temperature was uniformly cooled to 32 ℃, and HTK solution was infused from the root of the aorta to protect the myocardium.The size of tricuspid annulus, the lesion of tricuspid valve, the location and size of vegetation, the degree of valve lesion, the destruction of subvalvular structure and the formation of perivalvular abscess were examined routinely before operation.According to the results of exploration, different tricuspid valve operations were selected.Vegetation removal was performed in all cases. In patients with left heart valve disease or other intracardiac malformations, left heart valve surgery or intracardiac malformation correction should be performed first, followed by tricuspid valve surgery.After tricuspid valve treatment, the effect of tricuspid valvuloplasty, the opening and closing of tricuspid valve, conduction block and other arrhythmias were observed, and the residual tricuspid regurgitation was observed by drawing water.After operation, the effect of operation, tricuspid valve activity and residual regurgitation were evaluated again by transesophageal ultrasound.
Tricuspid valve plasty
For patients with moderate or severe tricuspid regurgitation, tricuspid valvuloplasty should be performed as far as possible if the tricuspid valve lobe and subvalvular structure are normal, the valve is not damaged, and the diameter of the diastolic tricuspid annulus is greater than 40mm.The methods of tricuspid valvuloplasty include Kay's valvuloplasty, DeVega valvuloplasty, pericardial patch valvuloplasty and artificial annuloplasty.
Tricuspid valve replacement
Tricuspid valve replacement should be performed in patients with tricuspid valve failure, poor tricuspid valvuloplasty or severe tricuspid valvuloplasty.During tricuspid valve replacement, artificial valves were implanted in situ, all the septal valves were preserved, and all or part of the subvalvular structures of tricuspid valves were selectively preserved during the operation.The anterior and posterior valve leaves were resected and sutured with 2-0 double-head needles with gaskets.Start from the septal lobe, insert the needle into the atrial surface, shallow suture at the root of the septal valve, and then sew to the free edge of the septal lobe to fold the septal valve leaf, strengthen the suture, avoid damaging the conduction bundle in the deep part of the valve ring, and prevent the suture from tearing the valve ring tissue.The anterior valve ring and the posterior valve ring were sutured according to this order, and then sutured to the artificial valve ring in turn, and the artificial valve was sent to the valve ring and tied with a knot.
The ACC time, CPB time, mechanical ventilation time, ICU stay time, perioperative red blood cell transfusion, pericardial drainage flow, total hospital stay, perioperative mortality and complication rate were collected. The postoperative 3-year, 5-year, 7-year survival rate and 5-year and 10-year reoperation rate were collected, and the results of echocardiography were followed up.
All statistical analyses were performed using SPSS 20.0 (SPSS, Chicago, IL). Data are expressed as percentages, mean±SD, Fisher’s exact test was applied for categoric variables, and the Mann-Whitney U test or Kruskal-Wallis test was applied for continuous variables. The actuarial survival and freedom from reoperation were calculated using the Kaplan-Meier method. A P value <0.05 was considered statistically significant.