关键词: 三尖瓣手术, 胸腔镜, 右胸小切口, 再次手术

Abstract: Objective To explore the effect of thoracoscopic-assisted tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement. Methods A retrospective analysis of 28 patients with tricuspid valve surgery with minimally invasive right thoracotomy after left heart valve replacement was conducted in the First Affiliated Hospital with Nanjing Medical University from May 2018 to July 2020.Nine patients underwent tricuspid valve repair and 19 patients underwent tricuspid valve replacement.All the patients underwent double-lumen tracheal intubation under general anesthesia,with the right chest elevated,the main operating hole of 5cm from the right midclavicular line to the right midaxillary line at the 4th intercostal space,and the observation hole of 1cm at the 5th intercostal incision at the right midaxillary line.Cardiopulmonary circulation was established through right femoral artery and vein cannulation,and tricuspid valve surgery was completed under heart beating. Results Only one patient died during the perioperative period,the patient developed acute renal failure combined with pulmonary infection,and the rest patients recovered well after the operation.All the operations were performed under cardiopulmonary bypass with continuous heart beating,no patients were converted to sternotomy,and there was no intraoperative complication.The cardiopulmonary bypass time was (78±15)min,postoperative ICU extubation time (20.3±8.6)h,postoperative hospital stay (8.5±3.0)days,no postoperative third-degree atrioventricular block,postoperative echocardiography showed no paravalvular leakage.The patients were followed up for 12 to 30 months,no death was found,and the cardiac function was improved compared with that before the operation. Conclusion Tricuspid valve surgery with thoracoscopic-assisted minimally invasive right thoracotomy after left heart valve replacement is a safe and feasible surgical method,which can significantly simplify the surgical process and reduce postoperative mortality and complications.

Key words: tricuspid valve surgery, thoracoscope, minimally invasive right thoracotomy, redo surgery