The Short To Mid-term Study Of Concomitant Totally Thoracoscopic Tricuspid Valve Repair

Objective:1.To discuss the short to mid-term effect of patients undergoing concomitant totally thoracoscopic tricuspid valve repair;2.To explore the risk factors of preoperative TR severity and postoperative TR recurrence;3.To Compare the surgical effect between Edwards MC3 ring and Balmedic ring.Methods:A total of 160 patients undergoing concomitant totally thoracoscopic TVP were enrolled retrospectively in this study,including 148 cases of artificial ring annuloplasty and 12 cases of kay technique.The patients were divided into mild,moderate,and severe groups according to the preoperative TR degree and pulmonary artery pressure.The patients with moderate to severe TR who undergoing artificial ring annuloplasty were divided into Edwards MC3 ring group(23 cases)and Balmedic ring group(40 cases).We compared the transthoracic echocardiography parameters at the time points before surgery,1 week,3 months and post 6 months after surgery.We studied the changes of TR area before and after operation in different TR degree groups and different pulmonary hypertension groups.Compare the surgical effect between Edwards MC3 ring and Balmedic ring.Logistic regression analysis was used to analyze the risk factors of preoperative TR severity and postoperative TR recurrence.Results:No death occurred after surgery and all patients were discharged.After the surgery,the left atrial diameter,right atrial diameter,left ventricular diameter and the pulmonary artery pressure were significantly reduced compared with that before the surgery(P < 0.05).The left atrial diameter,right atrial diameter,left ventricular diameter and the pulmonary artery pressure were significant differences between different TR degree groups.The higher degree of TR,the larger left atrial diameter,right atrial diameter,left ventricular diameter and higher pulmonary artery pressure(P<0.05).There were significant differences in TR area at different time points beforeand after operation in different TR degree groups.The higher the TR degree,the larger the TR area after surgery(P < 0.05).The preoperative TR area of different pulmonary artery pressure groups were different,the higher the pulmonary hypertension the larger preoperative TR area.And the postoperative TR area was significantly lower than that before surgery(P < 0.05).There were no significant differences in TR area between different pulmonary arterial pressure groups after 3months postoperatively(P>0.05).The TR area of the Edwards MC3 ring group and the Balmedic ring group were significantly reduced compared with that before the surgery(P<0.05).There were no significant differences in TR area between Edwards MC3 ring group and the Balmedic ring group(P > 0.05).Independent risk factors affecting the severity of TR are right atrial diameter,left ventricular diameter,and pulmonary arterial pressure.Independent risk factor for postoperative TR recurrence is pulmonary hypertension after half year postoperatively.(P<0.05)Conclusion:1.The concomitant totally thoracoscopic TVP can effectively reduce the TR area,reduce pulmonary artery pressure and improve right heart remodeling.The surgery is reliable,effective,and safe.The results in the near to mid-term were satisfactory.2.Independent risk factors affecting the severity of TR are right atrial diameter,left ventricular diameter,and pulmonary arterial pressure.Independent risk factor for postoperative TR recurrence is pulmonary hypertension persists after operation.Preoperative TR severity may promote postoperative TR recurrence.We recommended that TVP should be performed at the early stage of TR.Positive treatment of persistent pulmonary hypertension after surgery can improve prognosis of patients.3.The effect of the Edwards MC3 ring and the Balmedic ring in the application of moderate to severe TR patients demonstrates no significant difference in the short-middle term,but the long-term effects between them need further study.