Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

Abstract

Objective:  To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4) years), among them 197 (67.4%) women and 95 (32.6%) - men. According to the degree of circulatory disorders, 21 (7.2%) patients were in NYHA class III  and 271 (92.8%) patients - class IV. Of them 235 (80.5%) patients were operated by the method of De Vega using plastic fibrous ring.  After tricuspid valve (TV) and fibrous ring repair  in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had  2nd  (moderate) degree tricuspid regurgitation. In 7 (2.38%) cases of infective endocarditis, the "open heart surgery" correction – replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases.          Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation  and  reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.