The Investigation Of Ring Suturing Method For Functional Tricuspid Insufficiency Based On Chinese Anatomic Features

Purpose:To investigate the operative effects of continuous suture in tricuspid annulus plasty with septal annulus expansion,and summarize the clinical experience to improve the suturing method of functional tricuspid regurgitation.Methods:A retrospective study was performed during November 2015 to November 2017 in the First Affiliated Hospital of Zhejiang University.All the 96 patients were diagnosed of mitral valve disease combined with moderate or advanced functional tricuspid regurgitation.50 patients accepted tricuspid ring annuloplasty with continuous suture method.46 accepted tricuspid ring annuloplasty with interrupted mattress suture method.The surgeries were performed using the cardiopulmonary bypass(28-32?)under general anesthesia.After the mitral valve surgery was done,the tricuspid ring annuloplasty was performed followed the cardiac resuscitation.The size of the Sovering tricuspid ring was selected according to measurement results of the tricuspid annulus during the surgery.Using the interrupted mattress suture method,the tricuspid ring was sutured on the tricuspid annulus.Using the continuous suture method,the tricuspid ring was sutured on the right atrial muscle.All the patients were detected with echocardiography before surgery and 3 months after surgery.The echocardiography data of right atrium diameter,right ventricle diameter and pulmonary artery pressure were recorded.The different suture effects were analyzed.Results:The intraoperative water infusion test and esophageal echocardiography showed mild regurgitation.In the continuous suture group,there were 36 moderate regurgitation patients(72%)and 14 severe regurgitation patients(28%)before the surgery.After the surgery,48 patients(96%)had showed mild regurgitation and 2 patients(4%)had showed moderate regurgitation.The suprainferior diameter of the right atrium was 60.0±9.4 mm at 3 months after the surgery.Compared with the measurement before the surgery,the suprainferior diameter of the right atrium(68.2±11.4 mm)was significantly decreased(ANOVA,P<0.05).The right ventricle diameter was 21.8±7.1 mm at 3 months after the surgery.Compared with the measurement before the surgery,the right ventricle diameter(21.8±7.1 mm)was significantly decreased(ANOVA,P<0.05).The pulmonary arterial pressure was 44.1 +9.7 mmHg at 3 months after the surgery,which was also significantly lower(ANOVA,P<0.05).There was no significant difference in the effects between continuous suture group and interrupted mattress suture group.Conclusions:Using the continuous suturing method,the tricuspid ring annuloplasty could be well performed.The diameters of right ventricular and right atrial and the pulmonary artery pressure were significantly reduced.The tricuspid regurgitation with septal annulus expansion could be cured by tricuspid ring annuloplasty using continuous suturing method.The suturing method was helpful to rebuild structure and function the tricuspid annulus.