Perioperative Treatment Of Tricuspid Valve Replacement

Objective: In order to reduce surgical mortality and morbidity,it is summarize that the perioperative management experience of tricuspid valve replacement(TVR),including complications of treatment.Methods: A retrospective analysis of 45 cases of tricuspid valve replacement clinical data in Fujian Provincial Hospital from 2002 to 2012. Which have 1 case of traumatic tricuspid tear; 1 case of tricuspid valve degeneration; 11 cases of congenital heart disease, 4 cases of atrial septal defect, 3 cases of Ebstein malformation, including one case of sinus of Valsalva aneurysm repair surgery, one case of postoperative pericardial stripping, one case was corrected transposition of great arteries; 32 cases of rheumatic heart disease,8 cases after mitral and aortic valve replacement surgery, 12 cases of postoperative mitral valve(10 after mitral valve replacement, 1 each patient of closed separation and look into forming of mitral valve). It is implanted that 23 cases of mechanical valve and 22 cases of biological valve in Tricuspid position. The same period 4 repair of atrial septal defect, 1 forming of mitral valve, 11 replacement of mitral valve, 1 replacement of aortic valve, 1 repair of aortic paravalvular leakage, 7 replacement of mitral and aortic valve. It will be divided into rheumatic groups(32 cases) and non-rheumatic group(13 cases) according to the etiology of classification, and were compared on the difference of the situation before surgery and treatment.Results: 36 patients well out of the hospital, 9 patients died, perioperative mortality rate was 20%. The cause of death were low cardiac output syndrome(LCOS) and multiple organ failure(MOF) with each 3 and 6 cases. 44 cases of complications occurred during hospitalization times, including three cases of low cardiac output, six cases of multiple organ dysfunction syndrome(MODS), eight cases of lung infection, three cases of tracheotomy, one case of pulmonary edema, ten cases of arrhythmia, nine cases of pleural effusion, two cases of hoarseness, one case of the temporomandibular joint dislocation, one case of poor wound healing.It does not exist difference between Rheumatic and non-Rheumatic patients group in sex, average age, weight, cardiothoracic ratio, left ventricular ejection fraction(LVEF) and surgical incision, cardiopulmonary bypass time, the choice of valve types, 24 h pericardial mediastinal drainage, perioperative deaths. Only preoperative cardiac function was statistical significance between the two groups(P = 0.020).Conclusion: Patients are often severe illness during tricuspid valve replacement surgery, which have high perioperative mortality, and easy to be complications of postoperative low cardiac output, right ventricular failure, multiple organ dysfunction, arrhythmias and so on. To improve the success rate of surgery and its long-term survival, we should be do the three aspects. The first, perfect preoperative correlation test and inspection, actively improve heart function and myocardial energy reserves, adequate nutritional support, strict control of the timing of surgery and contraindications. Secondly,improve surgical techniques to avoid injury tracts, select the appropriate valve type, pay attention to myocardial protection and strengthen cooperation with cardiopulmonary division and anesthetists. The third, close postoperative monitoring of vital signs and central venous pressure, intake and output control, appropriate cardiac diuretic, maintain water and electrolyte acid-base balance, to prevent and treat a variety of complications, continue cardiac diuretic and anticoagulation therapy after leave hospital, according to the type of valve replacement, signs of bleeding, the type of arrhythmia and atrial size to develop individualized INR ratio range, and strengthen follow-up.