Comparison Of Two Types Of Tricuspid Valvuloplasty In The Treatment Of Functional Tricuspid Insufficiency

Objective: The clinical effects of two kinds of tricuspid valvuloplasty on functional tricuspid insufficiency were compared and analyzed.Method: The clinical data of 60 patients with functional tricuspid insufficiency who underwent tricuspid valvuloplasty in cardiac surgery department of our hospital from January 2014 to December 2018 were retrospectively analyzed.According to different surgical methods,it was divided into two groups: non-coannulus group and coannulus group.The upper ring group(30 cases)underwent artificial flap ring plasty.Preoperative general data,NYHA cardiac function grading,pulmonary artery pressure,color doppler ultrasound and other relevant observational indicators were collected for all patients upon admission.The surgical-related indicators during the operation were collected.Cardiac color doppler ultrasound and other related indicators were collected 1 week after surgery and 6 months after surgery.To observe the changes of right atrial diameter(RAD),RVD,tricuspid regurgitation,cardiac output(CO),intraoperative blockade time,cardiopulmonary bypass time,ventilator use time,ICU retention time and postoperative complications before and after surgery in the two groups of patients.The clinical effects of two kinds of tricuspid valvuloplasty on functional tricuspid insufficiency were compared and analyzed.Result:There were no deaths in either group.Postoperative complications were found in 7 patients in the non-coiling group.There were 2 cases of low cardiac output,2 cases of arrhythmia,2 cases of pulmonary infection,and 1 case of secondary thoracotomy for hemostasis.Postoperative complications occurred in 5 patients in the upper ring group.There were 1 case of low cardiac output,1 case of arrhythmia,2 cases of pulmonary infection,and 1 case of secondary thoracotomy for hemostasis.There was no statistically significant difference in aortic occlusion time,ventilator use time,ICU detention time,CPB time and hospital stay between the two groups(P >0.05).All patients were reviewed with color echocardiography upon discharge.There were 10 cases with mild reflux,3 cases with moderate reflux,and the rest without reflux.In the upper loop group,7 patients had mild reflux,and the others had no reflux.There was no significant difference in preoperative RAD,RVD,TR and CO between the two groups(P>0.05).In the two groups,RAD,RVD and TR decreased significantly 1 week after surgery and 6 months after surgery(P<0.05).In the two groups,CO increased significantly 1 week after surgery and 6 months after surgery compared with that before surgery(P<0.05).There were significant differences in RAD,RVD,TR and CO between the two groups 1 week after surgery and 6 months after surgery(P<0.05).After 6 months of follow-up,1 patient in the non-superior ring group developed medium-to-large tricuspid regurgitation with right heart failure and edema of the lower limb and it can be relieved by the application of cardiac tonic and diuretic.The cardiac function of 30 patients in the sheung wan group was significantly improved.There are no obvious symptoms such as right heart failure.Conclusions:1.Both linear suture and artificial annulus plasty can effectively treat functional tricuspid insufficiency.2.In the treatment of functional tricuspid insufficiency,the clinical effect of artificial annulus flap is better than that of linear suture.