Beating heart technique in tricuspid valve replacement among patients which have a TAPSE index lower than 15 mm

Abstract

Aim: Tricuspid valve replacement (TVR) has always been a compelling issue for cardiovascular surgeons due to the poor postoperative outcomes. Besides myocardial ischemia caused by aortic cross clamp, cardioplegia resulting in reperfusion injury is still one of the major problems in open heart surgery. In this study, we aimed to evaluate the benefits of TVR with beating heart (BH) in terms of decreasing mortality and morbidity rates among the patients with TAPSE indexes lower than 15 mm.
Methods: This research was designed as a retrospective cohort study. Twenty-nine patients with isolated tricuspid valve diseases with a TAPSE index lower than 15 mm and who underwent TVR consecutively between 2006 and 2012 were enrolled in this study. Among 29 patients, 13 underwent TVR with cardioplegic arrest (AH group) and 16 underwent TVR with a beating heart (BH group).
Results: There were 5 males in the AH group and 6 males in the BH group. The mean ages of the patients in AH and BH groups were 55.42 (11.6) years and 57.92 (8.43) years, respectively. Sixty-two percent of the AH group was in New York Heart Association (NYHA) Class III or IV heart failure in comparison to 56% of the BH group. Atrial fibrillation was present in 9 patients (69%) in the AH group and 11 patients (69%) in the BH group. Left ventricular functions were calculated as 57.23% (7.62) and 58.65% (8.02) in the AH and BH groups, respectively. Mean systolic pulmonary artery pressure was 38.45 (11.42) mmHg in AH group and 42.68 (13.01) mmHg in BH group. TAPSE score was 14.12 (1.78) in AH group and 13.67 (1.13) in BH group. Cardiopulmonary bypass times were 78.3 (19.8) minutes and 54 (14.6) minutes in the AH and BH groups, respectively, with respective total operation times of 167.4 (67.6) minutes and 132.2 (39.7) minutes (P=0.023). Positive inotropic drug use was observed in 9 patients (69%) in the AH group and in 7 patients (44%) in the BH group (P=0.029). The independent effect of BH in decreasing the mortality rates was calculated by logistic regression analysis (Odds ratio (OR) 0.43, 95% confidence interval (CI) 0.22–0.76, P=0.001).
Conclusion: Operative and postoperative outcomes of the BH technique in TVR encourage us to recommend using the BH technique in TVR among patients with a TAPSE score lower than 15 mm.

Keywords

• Tricuspid valve replacement,TAPSE,Beating Heart,Mortality

TAPSE değeri 15 mm altında olan hastalarda atan kalpte triküspit kapak replasmanı

Öz

Amaç: Triküspit kapak replasmanı (TKR) her zaman için kalp damar cerrahları için zorlayıcı bir durum olmuştur. Bunun yanında, aortik kros klemp neticesinde oluşan miyokardiyal iskemi, reperfüzyon hasarı ile sonuçlanan kardiyopleji halen kalp cerrahisindeki major problemlerin başında gelmektedir. Bu çalışmada, TAPSE değeri 15 mm altında olan hastalardaki mortalite ve morbiditeyi azaltmak açısından atan kalpte (AK) TKR ameliyatının yararlarını değerlendirmeyi amaçladık.
Yöntemler: Bu çalışma retrospektif kohort çalışma olarak tasarlanmıştır. İzole triküspid kapak hastalığı olan ve TAPSE değeri 15 mm altındaki 2006 ve 2012 yılları arasında TVR yapılan 29 hasta çalışmaya dahil edildi. Bu hastalardan 13'üne TVR kardiyoplejik arrest (KA grubu) ve 16'sına atan kalpte (AK grubu) uygulandı.
Bulgular: KA grubunda 13 kişiden 5'i erkek ve ortalama yaş 55,42 (11,6) idi. AK grubunda 16 kişiden 6'sı erkek ve ortalama yaş 57,92 (8,43) idi. KA grubunun %62'sinde New York Kalp Vakfı (NYHA) sınıf III veya IV iken AK grubunda bu oran %56 idi. Atriyal fibrilasyon KA grubunda 9 (%69) hastada görülürken AK grubunda 11 (%69) hastada gözlendi. Sol ventrikül fonksiyonu AK grubunda %57,23 (7,62) ve KA grubunda %58,65 (8.02) idi. Sistolik pulmoner arterial basınç KA grubunda 38,45 (11,42) mmHg iken AK grubunda 42,68 (13,01) mmHg idi. TAPSE skoru KA grubunda 14,12 (1,78) mm iken AK grubunda 13,67 (1,13) mm idi. Kardiyo pulmoner baypas zamanı KA grubunda 78,3 (19,8) dakika iken AK grubunda 54 (14,6) dakika idi (P=0,015), ve toplam ameliyat süresi KA grubunda 167,4 (67,6) dakika iken AK grubunda 132,2 (39,7) dakika olarak ölçüldü (P=0,023). Pozitif inotropik destek kullanımı KA grubunda 9 (%69) hastada görülürken AK grubunda 7 (%44) hastada mevcut idi (P=0,029). AK tekniğinin mortalite oranını düşürmedeki bağımsız etkisi lojistik regresyon analizi ile değerlendirildi (Odds ratio (OR) 0,43, 95% confidence interval (CI) 0,22–0,76, P=0,001).
Sonuç: AK ile TVR uygulamasına ait operasyonel ve postoperatif veriler bizleri TAPSE skoru 15 mm altında olan hastalarda AK tekniğinin kullanılmasını önermekte cesaretlendiriyor.

Anahtar Kelimeler

• TAPSE,Triküspit kapak replasmanı,Atan kalp,Mortalite

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