Clinical Analysis Of Forty-Three Cases Of Tricuspid Valve Replacement

Objective: The special object in presenting a clinical study on Tricuspid Valve Replacement (TVR) is to discuss reasons of Functional Tricuspid Insufficiency and to find out cause of the death of TVR based on data obtained from the analysis of forty-three clinical cases of TVR.Methods: From March 1999 to April 2010, we performed TVR on forty-three patients. Of these patients twenty-six have rheumatic heart disease, fourteen have congenital heart disease, two have degenerative tricuspid lesions, and one has tricuspid insufficiency after pericardiectomy. Furthermore, twenty-one patients keep full tricuspid valve, four keep diaphragmatic and back valves, one keep former valve, and others lose all valves after TVR. Three patients, especially, took TVR because of the imperfect result of tricuspid valvuloplasty. In total, we implanted twenty mechanical valves and fifteen biologic valves in the tricuspid position.Results: Nine patients died after the operation. That is,the mortality is 20.93% (9/43). In detail, two died of postoperative severe low cardiac output syndrome; three died of postoperative multiple organ failure; one died on that day for hard to stop extracorporeal circulation machine; one died of renal failure and vascular paralysis syndrome; one died of cardiac arrest for respiratory and renal failure 19 days after the operation; and one died of severe respiratory failure 26 days after the operation. The other 34 patients'aerage hospital days were 28.76±19.64, postoperative hospital days 19.79±16.57,in ICU days 6.59±15.32,using vasoactive drugs days after the operation 6.55±8.75. According to statistic results, all the patients in our study have significant symptoms of right heart disfunction before surgery, including twenty-three with abdominal distension (53.49%),twenty with two legs edema(46.51%),eleven with hepatosplenomegaly(25.58%). In addition, the preoperative sPAP is 46.68 mmHg in average and no statistical difference between survival group and dead group exists. There's significant difference between preoperative patients'heart structure and normal adults', and no improvement after the operation. The Central Venous Presure (CVP) of patients in our study didn't fall after the surgery, and some rose instead.Conclusion: Tricuspid insufficient(TI), especially functional tricuspid insufficient, is not only caused by the pulmonary hypertension, but also a clinical symptom of right heart and even the whole heart failure. Right heart insufficiency were bound up with the interaction between left and right ventricle, the effect of interventricular septum (IVS) on right ventricular function, the progression of valve disease and the change of blood volume. Although TVR resolves Tricuspid regurgitation(TR),it doesn't suit the remedy to the case. Therefore, we can't get effective treatment. Central Venous Pressure(CVP) is not only stand for the right atrial pressure,but also for the real Right Ventricular End Diastolic Pressure after TVP surgery. CVP is an independent risk factor for the operative mortality when it exceeds 18 cmH2O.When treat the perioperative TVR patients, we should make sure them with well-functioned hearts and maintain appropriate blood volume.