关键词: 心脏瓣膜置换术, 腔镜, 远期疗效, 心脏不停跳手术

Abstract: Objective To investigate the outcome of video-assisted and beating heart surgical treatment of severe tricuspid regurgitation late after valve replacement of left heart. Methods Eleven patients with severe tricuspid insufficiency,with the diagnosis conformed by echocardiogram,were treated surgically after left heart valve replacement from February 2009 to February 2018, including 8 mitral valve replacements and 3 double valve replacements. DeVega repair of tricuspid bad been used in 9 patients in the first operation. Results Tricuspid repair was performed in 2 patients,tricuspid replacement was done in 9 patients. The mechanical valves were implanted in 4 patients and biothesis valves in 5 patients.The low cardiac output and multiple organ failure were the causes of death. Two patients died during perioperative period （total hospital mortality was 18%）, both were valve replacement patients in cardioplegia group. Postoperative pericardial drainage volume in beating group were significantly less than those in cardioplegia group （P<0.05）. There were 4 cases of severe low cardiac output syndrome in cardiaplegia group and 1 case in beating group. Echocardiography showed that the right atrium and ventricle were significantly reduced and there was no or mild tricuspid regurgitation in the two groups. There was no significant difference between the two groups. The patients were followed up for 5.1 years （7 months~8 years）. Among the survivors, all patients showed improvement of symptoms,while most patients needed medical therapy. Conclusion The surgical intervention should be earlier before the onset of severe right ventricular failure. Minimally invasive beating heart surgery and proper peri-operative care is the key to successful operation. For end-stage cases, surgical mortality is high, the indication of valve replacement surgery should be cautious, cardiac ultrasound and magnetic resonance detection indicators for the right cardiac system should be actively carried out, and the surgical risk should be comprehensively evaluated.

Key words: left heart valve replacement, video-assisted surgery, beating heart surgery, late tricuspid valve insufficiency