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Trikuspidalklappenersatz bei erworbenem, isolierten Trikuspidalklappenvitium

Früh– und mittelfristige Ergebnisse

Tricuspid valve replacement for acquired isolated tricuspid valve disease – operative and mid–term results

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Zeitschrift für Herz-,Thorax- und Gefäßchirurgie Aims and scope

Zusammenfassung

Ein erworbenes isoliertes Trikuspidalklappenvitium ist eine seltene Herzklappenerkrankung. Wir möchten in dieser Arbeit die präoperativen Charakteristika sowie den Langzeitverlauf der Patienten darstellen, die sich in unserer Klinik einem isolierten Trikuspidalklappenersatz bei erworbenem Trikuspidalklappenvitium unterzogen haben.

Wir identifizierten 126 Patienten, die in unserer Klinik in einem Zeitraum vom 01. 01. 1985 bis 31. 07. 2003 einen Trikuspidalklappenersatz erhielten. 28 dieser Patienten (16 weiblich, mittleres Alter 53,6 Jahre) unterzogen sich 30 isolierten Trikuspidalklappenersätzen bei erworbener Trikuspidalklappeninsuffizienz.

Die mittlere Nachbeobachtungszeit betrug 38 (1–221) Monate. Bei 3 Patienten war die Ursache für die Trikuspidalklappeninsuffizienz eine floride Endokarditis, bei 6 Patienten eine chronische Endokarditis. 1 Patient litt unter einer chronischen Perimyokarditis, 2 unter einer hypertrophen, nicht–obstruktiven Kardiomyopathie und 1 unter einer Endomyokardfibrose. 4 Patienten waren herztransplantiert und bei einem Patienten lag ein Zustand nach zweimaliger Perikardresektion bei Perikarditis constrictiva vor. 3 Patienten waren auswärts voroperiert (2 Trikuspidalklappenersätze und 1 Trikuspidalklappenresektion).

Es wurden 10 biologische und 20 Alloprothesen implantiert. 1 Patient starb perioperativ (3,6%), 6 im Nachbeobachtungszeitraum (21%). 2 Patienten mussten sich einem Klappenaustausch unterziehen: eine Patientin nach Prothesenendokarditis einer biologischen Prothese, eine weitere Patientin nach Thrombosierung einer Alloprothese. Degeneration der biologischen Prothesen oder antikoagulantien–induzierte Blutungen wurden im Verlauf nicht beobachtet. 18 der überlebenden Patienten waren zum Zeitpunkt der Evaluation in NYHA–Klasse I, 2 Patienten in Klasse II und 1 Patient in Klasse II–III.

Ein isolierter Trikuspidalklappenersatz kann mit den derzeit verfügbaren Herzklappenprothesen sicher durchgeführt werden. Die mittelfristigen Ergebnisse sind akzeptabel und abhängig von Kormorbiditäten und der zugrunde liegenden Herzerkrankung.

Summary

Isolated tricuspid valve replacement for acquired tricuspid valve disease is rare. We studied the etiologies leading to tricuspid valve replacement, the preoperative conditions and the postoperative outcome of patients who underwent isolated tricuspid valve replacement at our institution.

From the clinical database we identified all patients (n = 126) who underwent tricuspid valve replacement between 01 January 1985 and 31 July 2003. We encountered 28 consecutive patients (16 female, mean age 53.6 years) who underwent 30 isolated tricuspid valve replacements for acquired tricuspid valve insufficiency.

The mean follow–up time for these patients averaged 38 (1–221) months. Tricuspid valve regurgitation was caused in 3 patients by infective, in 6 patients by healed endocarditis, 1 patient suffered from healed perimyocarditis, 2 from hypertrophic non–obstructive cardiomyopathy and 1 from endomyocardial fibrosis. In one patient the tricuspid insufficiency was related to constrictive pericarditis and in 4 patients to prior heart transplantation. Two patients underwent previous tricuspid valve replacement and one tricuspid valve resection in other institutions. Twenty patients received mechanical valves, 10 bioprostheses. One patient died perioperatively (3.6%), 6 during the follow–up time (21%). Two patients underwent a redo–operation, one due to prosthetic endocarditis of a biological prosthesis, the other after thrombosis of a mechanical prosthesis. No structural deterioration of biological prostheses, no bleeding due to anticoagulation with mechanical prostheses occurred. Of the surviving patients 18 were in New York Heart Association functional class I, two in class II and one in II–III at the time of the follow–up.

Isolated tricuspid valve replacement for acquired tricuspid valve insufficiency is rarely performed and due to a multitude of different etiologies. Perioperative mortality and morbidity and prosthesis related complications are comparatively lower than previously reported. The mid–term results are largely dependent on the etiology of the regurgitation and the patients’ comorbidity.

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Authors and Affiliations

  1. Klinik für Thoraxund Kardiovaskularchirurgie, Herz- und Diabeteszentrum NRW, Universitätsklinik der Ruhr-Universität Bochum, Georgstr. 11, 32545, Bad Oeynhausen, Germany

    Ariane Maleszka,  Bert Hansky,  Reiner Körfer PD &  Georg Kleikamp

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  1. Ariane Maleszka
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  2. Bert Hansky
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  3. Reiner Körfer PD
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  4. Georg Kleikamp
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Correspondence to Ariane Maleszka.

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Maleszka, A., Hansky, B., Körfer, R. et al. Trikuspidalklappenersatz bei erworbenem, isolierten Trikuspidalklappenvitium. Z Herz- Thorax- Gefäßchir 19, 162–166 (2005). https://doi.org/10.1007/s00398-005-0501-5

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  • DOI: https://doi.org/10.1007/s00398-005-0501-5

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