Beating heart technique in tricuspid valve replacement among patients which have a TAPSE index lower than 15 mm

Kıvanç Atılgan; Ertan Demirdaş

doi:10.28982/josam.699528

Authors

Kıvanç Atılgan https://orcid.org/0000-0001-9907-9879
Ertan Demirdaş https://orcid.org/0000-0002-7854-3481

DOI:

https://doi.org/10.28982/josam.699528

Keywords:

Tricuspid valve replacement, TAPSE, Beating Heart, Mortality

Abstract

Aim: Tricuspid valve replacement (TVR) has always been a compelling issue for cardiovascular surgeons due to the poor postoperative outcomes. Besides myocardial ischemia caused by aortic cross clamp, cardioplegia resulting in reperfusion injury is still one of the major problems in open heart surgery. In this study, we aimed to evaluate the benefits of TVR with beating heart (BH) in terms of decreasing mortality and morbidity rates among the patients with TAPSE indexes lower than 15 mm.
Methods: This research was designed as a retrospective cohort study. Twenty-nine patients with isolated tricuspid valve diseases with a TAPSE index lower than 15 mm and who underwent TVR consecutively between 2006 and 2012 were enrolled in this study. Among 29 patients, 13 underwent TVR with cardioplegic arrest (AH group) and 16 underwent TVR with a beating heart (BH group).
Results: There were 5 males in the AH group and 6 males in the BH group. The mean ages of the patients in AH and BH groups were 55.42 (11.6) years and 57.92 (8.43) years, respectively. Sixty-two percent of the AH group was in New York Heart Association (NYHA) Class III or IV heart failure in comparison to 56% of the BH group. Atrial fibrillation was present in 9 patients (69%) in the AH group and 11 patients (69%) in the BH group. Left ventricular functions were calculated as 57.23% (7.62) and 58.65% (8.02) in the AH and BH groups, respectively. Mean systolic pulmonary artery pressure was 38.45 (11.42) mmHg in AH group and 42.68 (13.01) mmHg in BH group. TAPSE score was 14.12 (1.78) in AH group and 13.67 (1.13) in BH group. Cardiopulmonary bypass times were 78.3 (19.8) minutes and 54 (14.6) minutes in the AH and BH groups, respectively, with respective total operation times of 167.4 (67.6) minutes and 132.2 (39.7) minutes (P=0.023). Positive inotropic drug use was observed in 9 patients (69%) in the AH group and in 7 patients (44%) in the BH group (P=0.029). The independent effect of BH in decreasing the mortality rates was calculated by logistic regression analysis (Odds ratio (OR) 0.43, 95% confidence interval (CI) 0.22–0.76, P=0.001).
Conclusion: Operative and postoperative outcomes of the BH technique in TVR encourage us to recommend using the BH technique in TVR among patients with a TAPSE score lower than 15 mm.

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References

Pfannmüller B, Davierwala P, Misfeld M, Borger MA, Garbade J, Mohr FW. Postoperative outcome of isolated tricuspid valve operation using arrested-heart or beating-heart technique. Ann Thorac Surg. 2012 Oct;94(4):1218-22. doi: 10.1016/j.athoracsur.2012.05.020. Epub 2012 Jun 28.

Lee CH, Laurence DW, Ross CJ, Kramer KE, Babu AR, Johnson EL, et al. Mechanics of the Tricuspid Valve-From Clinical Diagnosis/Treatment, In-Vivo and In-Vitro Investigations, to Patient-Specific Biomechanical Modeling. Bioengineering (Basel). 2019 May 22;6(2).pii:E47. doi: 10.3390/bioengineering6020047.

Ton-Nu TT, Levine RA, Handschumacher MD, Dorer DJ, Yosefy C, Fan D, et al. Geometric determinants of functional tricuspid regurgitation: insights from 3-dimensional echocardiography. Circulation. 2006 Jul 11;114(2):143-9.

Song JM, Jang MK, Kim YJ, Kim DH, Kang DH, Song JK. Right ventricular remodeling determines tricuspid valve geometry and the severity of functional tricuspid regurgitation: a real-time 3-dimensional echocardiography study. Korean Circ J. 2010 Sep;40 (9):448-53. doi: 10.4070/kcj.2010.40.9.448. Epub 2010 Sep 30.

Stuge O, Liddicoat J. Emerging opportunities for cardiac surgeons within structural heart disease. J Thorac Cardiovasc Surg. 2006 Dec;132(6):1258-61.

Braunwald NS, Ross J Jr, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation. 1967 Apr;35(4 Suppl):I63-9.

Schmid E, Hilberath JN, Blumenstock G, Shekar PS, Kling S, Shernan SK, et al. Tricuspid annular plane systolic excursion (TAPSE) predicts poor outcome in patients undergoing acute pulmonary embolectomy. Heart Lung Vessel. 2015;7(2):151-8.

Hasde AI, Ozcinar E, Cakici M, BaranC, Inan MB, Yazıcıoglu L, et al. Comparison of aortic cross-clamping versus beating heart surgery in tricuspid valve repair. Turkish Journal of Thoracic and Cardiovascular Surgery 2018;26(4):519-27. doi: 10.5606/tgkdc.dergisi.2018.16229

Di Mauro M, Bezante GP, Di Baldassarre A, Clemente D, Cardinali A, Acitelli A, et al. Functional tricuspid regurgitation: an underestimated issue. Int J Cardiol. 2013 Sep 30;168 (2):707-15. doi: 10.1016/j.ijcard.2013.04.043. Epub 2013 May 3.

Forfia PR, Fisher MR, Mathai SC, Housten-Harris T, Hemnes AR, Borlaug BA, et al. Tricuspid annular displacement predicts survival in pulmonary hypertension. Am J Respir Crit Care Med. 2006 Nov 1;174(9):1034-41.

Landis RC, Brown JR, Fitzgerald D, Likosky DS, Shore-Lesserson L, Baker RA, et al. Attenuating the Systemic Inflammatory Response to Adult Cardiopulmonary Bypass: A Critical Review of the Evidence Base. J Extra Corpor Technol. 2014 Sep;46(3):197-211.

Narayan P, Rogers CA, Bayliss KM, Rahaman NC, Panayiotou N, Angelini GD, et al. On-pump coronary surgery with and without cardioplegic arrest: comparison of inflammation, myocardial, cerebral and renal injury and early and late health outcome in a single-centre randomised controlled trial. Eur J Cardiothorac Surg. 2011 May;39(5):675-83. doi: 10.1016/j.ejcts.2010.08.032.

Rogers CA, Capoun R, Scott LJ, Taylor J, Jain A, Angelini GD, et al. Shortening cardioplegic arrest time in patients undergoing combined coronary and valve surgery: results from a multicentre randomized controlled trial: the SCAT trial. Eur J Cardiothorac Surg. 2017 Aug 1;52(2):288-96. doi: 10.1093/ejcts/ezx087.

Ellenberger C, Sologashvili T, Kreienbühl L, Cikirikcioglu M, Diaper J, Licker M. Myocardial Protection by Glucose-Insulin-Potassium in Moderate- to High-Risk Patients Undergoing Elective On-Pump Cardiac Surgery: A Randomized Controlled Trial. Anesth Analg. 2018 Apr;126(4):1133-41. doi: 10.1213/ANE.0000000000002777.

Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasashima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease. Ann Thorac Surg. 2002 Sep;74(3):678-83.

Orbay Yasli S, Tosun Z, Halici M, Kahraman Kayaalti S. Effects of high-dose tranexamic acid in total hip replacement: A prospective, double-blind, randomized controlled study. J Surg Med. 2019;3(1):39-43.

Campos IC, Tanganelli V, Maues HP, Coelho MCM, Martins FA, Munhoz G, et al. Blood Transfusion and Increased Perioperative Risk in Coronary Artery Bypass Grafts. Braz J Cardiovasc Surg. 2017;32(5):394-400.

Beckhoff F, Alushi B, Jung C, Navarese E, Franz M, Kretzschmar D, et al. Tricuspid Regurgitation - Medical Management and Evolving Interventional Concepts. Front Cardiovasc Med. 2018 May 28;5:49. doi: 10.3389/fcvm.2018.00049.

Paul DM, Naran A, Pierce EL, Bloodworth CH, Bolling SF, Yoganathan AP. Suture Dehiscence in the Tricuspid Annulus: An Ex Vivo Analysis of Tissue Strength and Composition. Ann Thorac Surg. 2017 Sep;104(3):820-6. doi: 10.1016/j.athoracsur.2017.02.040.