Triple valve correction of acquired heart disease
Abstract
Background. In the structure of cardiac surgery triple, valve correction is 1.2–10%.
Nevertheless, it is these patients who are in the most severe category, and
surgical treatment is accompanied by a higher hospital mortality rate compared
to one valve correction. Difficulties of diagnosis and determination of
indications for surgery in three valvular lesions, the main reason for untimely
referral of patients to surgical treatment.
Aim. Evaluation of immediate results of triple heart disease surgery.
Material and
methods. A computerized database of the department’s surgical
activities was used. A retrospective analysis of the surgical treatment of 61
patients with acquired triple valve heart disease was performed. The age of the
patients ranged from 41 to 81 years with average age of 60.6±9.8 years, 37 men
(60.7%) and 24 women (39.3%). Surgical intervention was repeated in 12 (19.7%)
cases (in 4 cases after “closed” mitral commissurotomy, in 6 the first
operation was performed under cardiopulmonary bypass, and in 2 cases a
pacemaker was implanted. Patients belonged to functional class III and IV of
heart failure according to NYHA in 70.5 and 13.1% of cases, respectively.
Results. There were 2 deaths during the hospital period. The mortality rate was
3.2%. In the postoperative stage, 48 patients required cardiotonic support of
variable extent. The most common complication was rhythm disturbances: atrial
fibrillation (15), nodal rhythm (12), frequent ventricular extrasystole (2) and
complete transverse block in one observation. It should be noted that out of 10
patients with rhythm-converting surgery, 8 were discharged with sinus rhythm.
Neurological complications were noted in 2 patients, pneumonia in 4. In one
observation, wound infection, pneumothorax, hydrothorax and lymphorhea in the
area of the postoperative suture on the thigh were noted.
Conclusion. Triple-valve lesion is the most complex in the section of cardiac
surgery of heart lesions. Indications for correction are based on the clinical
data and their consideration with functional assessment methods (ECG, ECHO CG).
Unlike isolated defects, data on morphological changes in the valves and
indicators of degree of cardiac remodeling (volume indicators of the heart
cavities, myocardial mass), assessed with ECHO CG, are of paramount importance.
A timely operation
allows minimizing the risks of surgical treatment and predicting a major
improvement in the quality of life. However, for a number of reasons, it is
patients with multivalvular disease who turn to cardiac surgeons at the later
stages of the disease. Despite the high risk, surgical treatment remains the
only way to normalize intracardiac hemodynamics and improve the quality of life.
Keywords:triple valve heart disease correction; multivalvular heart disease; valvular heart disease
Funding. The study had no sponsor support.
Conflict of
interest. The authors declare no conflict of interest.
For citation: Ivanov V.A., Aidamirov Ya.A., Evseev E.P., Ivanova L.N., Nikityuk T.G.
Triple valve correction of acquired heart disease. Clinical and Experimental
Surgery. Petrovsky Journal. 2023; 11 (4): 90–7. DOI: https://doi.org/10.33029/2308-1198-2023-11-4-90-97 (in Russian)
References
1. Cheng Y.-Y., Brieger D., Bannon P., Chow V., Kritharides L., Ng A.C.C. Outcomes following triple cardiac valve surgery over 17-years: a multicentre population-linkage study. Heart Lung Circ. 2023; 32 (2): 269–77. DOI: https://doi.org/10.1016/j.hlc.2022.09.018
2. Lee R., Li S., Rankin J.S., O’Brien S.M., Gammie J.S., Peterson E.D., et al.; Society of Thoracic Surgeons Adult Cardiac Surgical Database. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg. 2011; 91 (3): 677–84. DOI: https://doi.org/10.1016/j.athoracsur.2010.11.009
3. Davoodi S., Karimi A., Ahmadi S.H., Marzban M., Movahhedi N., Abbasi K., et al. Short- and mid-term results of triple-valve surgery with an evaluation of postoperative quality of life. Tex Heart Inst J. 2009; 36 (2): 125–30.
4. Leonea A., Fortunab D., Gabbieric D., Nicolinid F., Continid G.A., Piginie F., et al.; RERIC (Emilia Romagna Cardiac Surgery Registry) Investigators. Triple valve surgery: results from a multicenter experience. J Cardiovasc Med. 2018; 19: 382–88. DOI: https://doi.org/10.2459/JCM.0000000000000665
5. Alsoufi B., Rao V., Borger M.A., Maganti M., Armstrong S., Feindel C.M., et al. Short- and long-term results of triple valve surgery in the modern era. Ann Thorac Surg 2006; 81: 2172–8.
6. Davarpasand T., Hosseinsabet A. Triple valve replacement for rheumatic heart disease: short- and mid-term survival in modern era. Interact Cardiovasc Thorac Surg. 2015; 20: 359–64. DOI: https://doi.org/10.1093/icvts/ivu400
7. Lioa A., Murzia M., Di Stefanoa G., Micelib A., Kallushia E., Ferrarinib M., et al. Triple valve surgery in the modern era: short- and long-term resultsfrom a single centre Interact Cardiovasc Thorac Surg. 2014; 19: 978–84. DOI: https://doi.org/10.1093/icvts/ivu273
8. Saha S., Varghese S., Al Ahmad A., Jebran A.F., Waezi N., Niehaus H., et al. Complex valve surgery in elderly patients: increasingly necessary and surprisingly feasible. Thorac Cardiovasc Surg. 2020; 68 (2): 107–13. DOI: https://doi.org/10.1055/s-0038-1670663
9. Sakamoto Y., Hashimoto K., Okuyama H., Ishii S., Inoue T., Kinouchi K. Long-term results of triple-valve procedure. Asian Cardiovasc Thorac Ann 2006; 14: 47–50.
10. Guidelines and standards. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015; 28 (1): 1–39.e14. DOI: https://doi.org/10.1016/j.echo.2014.10.003
11. Vahanian A., Beyersdorf F., Praz F., Milojevic M., Baldus S., Bauersachs J., et al.; ESC/EACTS Scientific Document Group; ESC National Cardiac Societies. 2021 ESC/EACTS Guidelines for the management of valvular heart disease: developed by the Task Force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022; 43 (7): 561–632. DOI: https://doi.org/10.1093/eurheartj/ehab395
12. Poostizadeh A., Jamieson E., Munro A.I., Miyagishima R.T., Ling H., Fradet G.J., et al. Considerations for prostheses choice in multiple valve surgery. J Cardiothorac Surg. 2021: 16: 262. DOI: https://doi.org/10.1186/s13019-021-01631-7
13. Shinn S.H., Oh S.S., Na C.Y., Lee C.H., Lim H.G., Kim J.H., et al. Short- and long-term results of triple valve surgery: a single center experience. J Korean Med Sci 2009; 24: 818–23. ISSN 1011-8934 DOI: https://doi.org/10.3346/jkms.2009.24.5.818
14. Ivanov V.A., Trekova N.A., Evseev E.P., Nikityuk T.G., et al. Surgical and anesthetic aspects of radical correction of critical aortic stenos. Kardiologiya i serdechno-sosudistaya khirurgiya [Cardiology and Cardiovascular Surgery]. 2019; 12 (4): 266–72. (in Russian))
15. Moront M.G., Kuehne M., Redfern R.E. Minimally invasive triple valve surgery: a single center experience. J Card Surg. 2020; 35: 2567–73. DOI: https://doi.org/10.1111/jocs.14835
16. Lio A., Miceli A., Ferrarini M., Glauber M. Minimally invasive approach for double and triple valve surgery. J Vis Surg. 2019; 5: 1. DOI: https://doi.org/10.21037/jovs.2018.12.12