Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience
BackgroundLate severe tricuspid regurgitation (TR) after left-side valve surgery (LSVS) is not uncommon. However, the tricuspid valve has been deemed the forgotten valve because the isolated TR is well tolerated with medication, and reoperation has a higher rate of adverse events. With the advanceme...
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Frontiers Media S.A.
2023-02-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1033489/full |
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| author | Jian Liu Jian Liu Tong Tan Tong Tan Tong Tan Huanlei Huang Huanlei Huang Wenda Gu Wenda Gu Xin Zang Xin Zang Jianrui Ma Jianrui Ma Jianrui Ma Hongxiang Wu Hongxiang Wu Haozhong Liu Haozhong Liu Haozhong Liu Jian Zhuang Jian Zhuang Jimei Chen Jimei Chen Huiming Guo Huiming Guo |
| author_facet | Jian Liu Jian Liu Tong Tan Tong Tan Tong Tan Huanlei Huang Huanlei Huang Wenda Gu Wenda Gu Xin Zang Xin Zang Jianrui Ma Jianrui Ma Jianrui Ma Hongxiang Wu Hongxiang Wu Haozhong Liu Haozhong Liu Haozhong Liu Jian Zhuang Jian Zhuang Jimei Chen Jimei Chen Huiming Guo Huiming Guo |
| author_sort | Jian Liu |
| collection | DOAJ |
| description | BackgroundLate severe tricuspid regurgitation (TR) after left-side valve surgery (LSVS) is not uncommon. However, the tricuspid valve has been deemed the forgotten valve because the isolated TR is well tolerated with medication, and reoperation has a higher rate of adverse events. With the advancement of minimally invasive techniques, isolated tricuspid valve reoperation (ITVR) via totally endoscopy or transcatheter approach brings the tricuspid valve into spotlight. Our aim is to report the safety and efficacy of minimally invasive ITVR using endoscopic and transcatheter approaches.MethodsFrom October 2020 to October 2021, 21 patients with LSVS history and secondary massive TR underwent minimally invasive ITVR in our institution. Baseline characteristics, surgical outcomes and follow-up results were analyzed, and data between the totally endoscopy approach and the transcatheter approach were compared.ResultsOf the 21 cases, totally endoscopic isolated tricuspid valve surgery (EITVS) accounts for 16 (76.2%) cases, with 14 tricuspid valvuloplasty cases, and 2 tricuspid valve replacement cases; the remaining 5 (23.8%) cases underwent transcatheter tricuspid valve replacement (TTVR). The mean age was (60.0 ± 8.4) years, with 15 (71.4%) being female. Minimally invasive ITVR procedures were 100% successfully performed in all patients without any perioperative mortality, sternotomy conversion, or reoperation. During the median follow-up of 16.8 months (IQR, 13.0–20.6 months), New York Heart Association Class improved significantly from baseline (P = 0.004). TR severity was significantly improved during postoperative and follow-up period (both P < 0.001). Compared with the EITVS group, the TTVR group had a higher clinical risk score [8.00 (8.00, 9.00) vs. 5.00 (3.25, 5.00), P = 0.001], but a higher success rate in reducing TR to less than grade 1+ (100 vs. 43.8%, P = 0.045) at follow-up.ConclusionIn our series, minimally invasive ITVR, including EITVS and TTVR, is a safe and feasible option for severe TR after LSVS, and presents excellent early outcomes in selected patients. TTVR is a reliable alternative for patients with high surgical risk. To improve the results of ITVR, it is necessary to improve patient’s preoperative status or perform reoperation before the onset of significant right heart failure. Further studies with a larger sample size and a longer follow-up period are awaited. |
| first_indexed | 2024-04-10T18:53:19Z |
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| publishDate | 2023-02-01 |
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| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj.art-2054d8aa64c04ccbbc0a371d8a9134a02023-02-01T04:46:41ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2023-02-011010.3389/fcvm.2023.10334891033489Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experienceJian Liu0Jian Liu1Tong Tan2Tong Tan3Tong Tan4Huanlei Huang5Huanlei Huang6Wenda Gu7Wenda Gu8Xin Zang9Xin Zang10Jianrui Ma11Jianrui Ma12Jianrui Ma13Hongxiang Wu14Hongxiang Wu15Haozhong Liu16Haozhong Liu17Haozhong Liu18Jian Zhuang19Jian Zhuang20Jimei Chen21Jimei Chen22Huiming Guo23Huiming Guo24Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaShantou University Medical College, Shantou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaShantou University Medical College, Shantou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaShantou University Medical College, Shantou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaDepartment of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, ChinaGuangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangzhou, ChinaBackgroundLate severe tricuspid regurgitation (TR) after left-side valve surgery (LSVS) is not uncommon. However, the tricuspid valve has been deemed the forgotten valve because the isolated TR is well tolerated with medication, and reoperation has a higher rate of adverse events. With the advancement of minimally invasive techniques, isolated tricuspid valve reoperation (ITVR) via totally endoscopy or transcatheter approach brings the tricuspid valve into spotlight. Our aim is to report the safety and efficacy of minimally invasive ITVR using endoscopic and transcatheter approaches.MethodsFrom October 2020 to October 2021, 21 patients with LSVS history and secondary massive TR underwent minimally invasive ITVR in our institution. Baseline characteristics, surgical outcomes and follow-up results were analyzed, and data between the totally endoscopy approach and the transcatheter approach were compared.ResultsOf the 21 cases, totally endoscopic isolated tricuspid valve surgery (EITVS) accounts for 16 (76.2%) cases, with 14 tricuspid valvuloplasty cases, and 2 tricuspid valve replacement cases; the remaining 5 (23.8%) cases underwent transcatheter tricuspid valve replacement (TTVR). The mean age was (60.0 ± 8.4) years, with 15 (71.4%) being female. Minimally invasive ITVR procedures were 100% successfully performed in all patients without any perioperative mortality, sternotomy conversion, or reoperation. During the median follow-up of 16.8 months (IQR, 13.0–20.6 months), New York Heart Association Class improved significantly from baseline (P = 0.004). TR severity was significantly improved during postoperative and follow-up period (both P < 0.001). Compared with the EITVS group, the TTVR group had a higher clinical risk score [8.00 (8.00, 9.00) vs. 5.00 (3.25, 5.00), P = 0.001], but a higher success rate in reducing TR to less than grade 1+ (100 vs. 43.8%, P = 0.045) at follow-up.ConclusionIn our series, minimally invasive ITVR, including EITVS and TTVR, is a safe and feasible option for severe TR after LSVS, and presents excellent early outcomes in selected patients. TTVR is a reliable alternative for patients with high surgical risk. To improve the results of ITVR, it is necessary to improve patient’s preoperative status or perform reoperation before the onset of significant right heart failure. Further studies with a larger sample size and a longer follow-up period are awaited.https://www.frontiersin.org/articles/10.3389/fcvm.2023.1033489/fullminimally invasivetricuspid regurgitationisolated tricuspid valve reoperationtranscatheter tricuspid valve replacementventricular dysfunction |
| spellingShingle | Jian Liu Jian Liu Tong Tan Tong Tan Tong Tan Huanlei Huang Huanlei Huang Wenda Gu Wenda Gu Xin Zang Xin Zang Jianrui Ma Jianrui Ma Jianrui Ma Hongxiang Wu Hongxiang Wu Haozhong Liu Haozhong Liu Haozhong Liu Jian Zhuang Jian Zhuang Jimei Chen Jimei Chen Huiming Guo Huiming Guo Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience Frontiers in Cardiovascular Medicine minimally invasive tricuspid regurgitation isolated tricuspid valve reoperation transcatheter tricuspid valve replacement ventricular dysfunction |
| title | Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience |
| title_full | Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience |
| title_fullStr | Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience |
| title_full_unstemmed | Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience |
| title_short | Outcomes of minimally invasive isolated tricuspid valve reoperation after left-side valve surgery: A single-center experience |
| title_sort | outcomes of minimally invasive isolated tricuspid valve reoperation after left side valve surgery a single center experience |
| topic | minimally invasive tricuspid regurgitation isolated tricuspid valve reoperation transcatheter tricuspid valve replacement ventricular dysfunction |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2023.1033489/full |
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