Scientific journal
European Journal of Natural History
ISSN 2073-4972

THORACOTOMY APPROACH IN REPLACEMENT OF TRICUSPID VALVE: TACTICS AND OUTCOMES

Abzaliev K.B. 1 Kuzhukeyev M.E. 1 Dosmailov N.S. 2
1 Kazakh Medical University for Continuing Education
2 National Scientific Center of Surgery named after A.N. Syzganov

Objective of the research: define surgical tactics for replacement of tricuspid valve.

Material and methods: From 2007 to 2014, eighteen patients underwent tricuspid-valve replacement (TVR) at the National Scientific Center of Surgery named after A.N. Syzganov. In half (nine patients), TVR followed prior operations on repair of acquired heart diseases. Six patients (33,3 %) had Ebstein anomaly, two were drug addicts with infective endocarditis, and another one had traumatic tricuspid regurgitation. Four were male, 14 female (22,2 % vs. 77,7 %). Two (11,11 %) were in ACC stage B, with remaining sixteen (88,9 %) in ACC stage 3. Four (22,2 %) patients were in NYHA class III, while 14 (77,7 %) were in NYHA class IV. Fourteen had regurgitation Grade 3 to 4, two patients had combined heart disease, while two had stenotic tricuspid valve with calcified cusps.

Results: All eighteen patients underwent tricuspid-valve replacement: four (22,2 %) were implanted with MedInge-2 33 sized prosthesis (Russia), while fourteen (77,8 %) were implanted with bioprostheses (Pericor, Comcor, Russia). In nine patients (50 %) who previously underwent mitral and aortic valve replacement and were on continuous anticoagulation, the following tactics was chosen: right sided thoracotomy approach through the 4th intercostal space was attempted in 6 (66,7 %) patients, CPB was initiated in a standard way, though a 9-size cuffed intubation tubes were used instead of venous cannulae through the pericardium, without any cardiolysis. This helped us avoid circumventing the venae cavae, thus considerably reducing the bleeding. In three patients, the heart prostheses were implanted under parallel perfusion, using continuous Prolene 2/0 suture, with 2 or 3 mattress sutures in the bundle of His area.

In 8 of 18 cases the aortic cannula was inserted in the ascending aorta, while in the remaining cases the left femoral artery was cannulated. In nine patients, we were lucky not to release the heart of cohesions and had a routine operation. Four patients (22,2 %) required inotropic support with Dopamine (5 mg/kg body weight per minute), another four (22,2 %) needed up to 10 mg/kg body weight per minute. The rest of the patients did not require any cardiotonic agents. No deaths or complications were observed. The patients were discharged on day 12 to 14 post-op.

Coclusions: In patients with previously implanted mitral or aortic prostheses and on VKA anticoagulation, tricuspid-valve replacement should be performed via thoracotomy, under parallel perfusion, with 9-size cuffed intubation tubes used instead of venous cannulae. This does not deteriorate the pump and contractile function of the left ventricle, while improving the respiratory dysfunction. When performing primary tricuspid valve repair, the surgical approach and all the rest is done a routine fashion.


The work is submitted to the International Scientific Conference “Fundamental research”, CROATIA (Istria) 23 July–30 July 2015, came to the editorial office оn 20.07.2015.