Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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The Early Results of Tricuspid Valvuloplasty with Using the Edwards MC3 Annuloplasty System

Edwards MC3 Annuloplasty System을 이용한 삼첨판 성형술의 조기 성적

  • Oh, Tak-hyuck (Department of Thoracic and Cardiovascular Surgery, Kypook Natinonal University Hospital, Kyungpook National University College of Medicine) ;
  • Cho, Joon-Yong (Department of Thoracic and Cardiovascular Surgery, Kypook Natinonal University Hospital, Kyungpook National University College of Medicine) ;
  • Lee, Jong-Tae (Department of Thoracic and Cardiovascular Surgery, Kypook Natinonal University Hospital, Kyungpook National University College of Medicine) ;
  • Kim, Gun-Jik (Department of Thoracic and Cardiovascular Surgery, Kypook Natinonal University Hospital, Kyungpook National University College of Medicine) ;
  • Kim, Dae-Hyun (Department of Thoracic and Cardiovascular Surgery, Changwon Fatima Hospital)
  • 오탁혁 (경북대학교 의과대학 경북대학교병원 흉부외과학교실) ;
  • 조준용 (경북대학교 의과대학 경북대학교병원 흉부외과학교실) ;
  • 이종태 (경북대학교 의과대학 경북대학교병원 흉부외과학교실) ;
  • 김근직 (경북대학교 의과대학 경북대학교병원 흉부외과학교실) ;
  • 김대현 (창원파티마병원 흉부외과)
  • Received : 2008.11.10
  • Accepted : 2008.12.17
  • Published : 2009.02.05
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Abstract

Background: Functional tricuspid regurgitation (TR) greater than or equal to a mild grade requires tricuspid valvuloplasty, and tricuspid valvuloplasty with ring annuloplasty has shown good outcomes. We report here on our early experience with the Edwards $MC^3$ annuloplasty system (Edwards LifeSciences, Irvine, CA). Material and Method: From November 2004 to July 2006, 72 patients with tricuspid annular dilatation and TR underwent tricuspid valvuloplasty with using the Edwards $MC^3$ annuloplasty ring. Sixty-eight patients were operated on via median sternotomy and four patients were operated on using robotic assisted minimal invasive thoracotomy. The patient population included 21 males and 51 females and their mean age was $53.9{\pm}12.3$. The mean grade of TR, as assessed by the preoperative echocardiography, was $2.2{\pm}1.0$. The mean NYHA functional class was $3.1{\pm}0.8$. The mean left ventricular ejection fraction was $57.0{\pm}9.9$%. Result: The TR and NYHA functional class, as assessed by postoperative echocardiography, was significantly reduced (mean=$0.4{\pm}0.6$ and $2.0{\pm}0.7$, respectively p<0.001). There was one case of hospital mortality. One patient required permanent pacemaker insertion for third degree atrioventricular block. Conclusion: Our study shows that the Edwards $MC^3$ remodeling ring is easy to implant and it effectively corrects functional TR with excellent clinical and echocardiographic outcomes. Further follow-up and a larger clinical series are required to establish the long-term stability of this repair technique.

배경: 경도이상의 기능성 삼첨판막 폐쇄부전이 있는 경우 삼첨판 성형술이 널리 시행되고 있으며, 판륜링을 이용한 성형술이 우수한 성적을 나타내고 있다. 우리는 새로운 삼차원적 모양의 삼첨판륜링(Edwards $MC^3$ annuloplasty system [Edward LifeSciences, Irvine, CA])을 이용한 삼첨판 성형술의 조기성적을 보고하고자 한다. 대상 및 방법: 2004년 11월부터 2006년 7월까지 삼첨판륜의 확장 및 경도이상의 삼첨판막 폐쇄부전이 있는 72명의 환자에서 Edwards $MC^3$ annuloplasty ring을 이용한 삼첨판 성형술을 시행하였다. 72명의 환자 중, 68명에서 정중흉골절개술을 하였고 4명에서 로봇팔을 이용한 최소절개 개흉술을 시행하였다. 남녀비는 21 : 51이었고 평균 나이는 $53.9{\pm}12.3$세였다. 수술 전 삼첨판막 폐쇄부전은 평균 $2.2{\pm}1.0$도였으며 평균 NYHA functional class는 $3.1{\pm}0.8$, 평균 좌심실박출계수는 $57.0{\pm}9.9$%였다. 결과: 삼첨판막 폐쇄부전과 NYHA functional class는 각각 $0.4{\pm}0.6$, $2.0{\pm}0.7$으로 의미있게 감소하였고 삼첨판막 협착은 없었다(p<0.001). 병원 사망은 1명이 있었으며 술 후 합병증은 3도 블록이 발생하여 영구적 인공심박동기 삽입을 한 경우가 1명이 있었다. 결론: 3차원적 모양의 삼첨판륜링은 장착하기 용이하며 임상적, 심초음파 검사상 단기성적은 우수한 것으로 판단된다. 그러나 이 판막륜링의 장기 성적에 대하여는 연구 대상환자에 대한 정기적인 추적관찰 및 검사가 필요하고 더 많은 임상 적용 및 경험이 필요할 것으로 판단된다.

Keywords

References

  1. Cohen SR, Sell JE, McIntosh CL, et al. Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. II. Nonoperative management, tricuspid valve annuloplasty, and tricuspid valve replacement. J Thorac Cardiovasc Surg 1987;94:488-97
  2. Nakano S, Kawashima Y, Hirose H, et al. Evaluation of long-term results of bicuspidalization annuloplasty for functional tricuspid regurgitation: a seventeen-year experience with 133 consecutive patients. J Thorac Cardiovasc Surg 1988;95:340-5
  3. Kay GL, Morita S, Mendez MA, Zubiate P, Kay HJ. Tricuspid regurgitation associated with mitral valve disease: repair and replacement. Ann Thorac Surg 1989;48:593-5
  4. McGrath LB, Gonzalez-Lavin L, Bailey BM, Grunkemeier GL, Fernandez J, Laub GW. Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events. J Thorac Cardiovasc Surg 1990;99:124-33
  5. Dreyfus GD, Corbi PJ, John Chan KM, Bahrami T. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg 2005;79:127-32 https://doi.org/10.1016/j.athoracsur.2004.06.057
  6. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004;43:405-9. https://doi.org/10.1016/j.jacc.2003.09.036
  7. Kay GL, Morita S, Mendez M, et al. Tricuspid regurgitation associatied with mitral valve diseas: repair and replacement. Ann Thorac Surg 1989;48(Suppl 3):S93-5 https://doi.org/10.1016/0003-4975(89)90656-5
  8. De Vega NG, De Rabago G, Castillon L, et al. A new tricuspid repair: short-term clinical results in 23 cases. J Cardiovasc Surg(Torino) 1973;Spec No.:384-6
  9. Bernal JM, Morales D, Revuelta C, et al. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg 2005;130: 498-503 https://doi.org/10.1016/j.jtcvs.2004.12.044
  10. Carpentier A, Deloche A, Dauptain J, et al. A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 1971;61:1-13
  11. McCarthy JF, Cosgrove DM 3rd. Tricuspid valve repair with the Cosgrove-Edwards annuloplasty system. Ann Thorac Surg 1997;64:267-8 https://doi.org/10.1016/S0003-4975(97)00348-2
  12. Carrier M, Pellerin M, Guertin MC, et al. Twenty-five years’ clinical experience with repair of tricuspid insufficiency. J Heart Vavle Dis 2004;13:952-6
  13. Carpentier A. Cardiac vavle surgery-the “French correction.” J Thorac Cardiovasc Surg 1983;86:323-37
  14. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cariovasc Surg 2004;127:674-85 https://doi.org/10.1016/j.jtcvs.2003.11.019
  15. Rivera R, Duran E, Ajuria M. Carpentier’s flexible ring verus De Vega’s annuloplasty: a prospective randiomized study. J Thorac Cardiovasc Surg 1985;89:196-203
  16. Matsuyama K, Matsumoto M, Sugiat T, et al. De Vega annuloplasty and Carpentier-Edwards ring annuloplasty for secondary tricuspid regurgitation. J Heart Vavle Dis 2001; 10:520-4
  17. Kuwaki K, Morishita K, Tsukamoto M, Abe T. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg 2001;20:577-82. https://doi.org/10.1016/S1010-7940(01)00786-2
  18. Gatti G, Maffei G, Lusa AM, Pugliese P. Tricuspid valve repair with the Cosgrove-Edwards Annuloplasty system: Early clinical and echocardiographic results. Ann Thorac Surg 2001;72:764-7 https://doi.org/10.1016/S0003-4975(01)02830-2
  19. Porter A, Shapira Y, Wurzel M, et al. Tricuspid regurgitation late after mitral valve replacement: clinical and echocardiographic evaluation. J Heart Valve Dis 1999;8: 57-62
  20. Braunwald NS, Ross J, Morrow AG. Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement. Circulation 1967;35(suppl):I63-9