Triple valve correction of acquired heart disease

• Viktor A. Ivanov
• Aydamirov Ya.A.
• Evgeny P. Evseev
• Lyubov N. Ivanova
• Tatyana G. Nikityuk

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

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