Bicuspidization versus segmental annuloplasty in tricuspid valve repair

The tricuspid valve remains a challenge to the surgeons despite statements to the contrary. Although modern techniques have significantly reduced the mortality and morbidity of tricuspid repair, its indications remain controversial. Some surgeons recommend replacement, others repair, and some even suggest that the valve be ignored. This study was carried out to evaluate and compare bicuspidization repair [1st group] and segmental annuloplasty [2nd group] in repair of functional tricuspid regurgitation and to assess performance of tricuspid valve following these two techniques. During this study, fifty patients underwent tricuspid valve surgery for repair of functional tricuspid valve regurgitation secondary to rheumatic mitral with or without aortic valve pathology, in the period between November 2000 and December 2002 in The Department of Cardiothoracic Surgery, Kasr Al Aini Hospital, Cairo University. In all patients, left sided lesions [mitral with or without aortic valve lesion] were corrected during the same surgical procedure before tricuspid valve repair using mitral valve repair or replacement [for mitral valve lesions]; or aortic valve replacement for Aortic Valve Lesions. In all patients, tricuspid valve repair was performed. Patients were randomized into two groups 1st group [no. 25] included patients who underwent bicuspidization repair of their functional TR; whereas 2nd group [no: 25] included patients who underwent segmental annuloplasty for repair of their functional TR. Of the 50 patients operated upon in this study, 25 patients had bicuspidization and the other 25 had segmental annuloplasty for repair of their significant moderate to severe functional tricuspid incompetence secondary to rheumatic left sided valvular pathology. Both groups had preoperative and postoperative clinical, laboratory, electrocardiographic, radiographic and echocardiographic evaluation, 3 and 6 months after discharge from hospital. No mortality occurred in any of our patients. Tricuspid valve competence was restored in nearly 80% of all cases with only mild residual tricuspid insufficiency in about 20% of patients in the immediate postoperative period. Follow up after 3 and 6 months revealed recurrence of moderate tricuspid insufficiency in 4 patients [16%] in the l st group and 5 patients [20%] in the 2 nd group with no statistically significant difference between both groups. The simplicity of the two techniques, their efficacy and relative durability justifies their use in repair of functional tricuspid insufficiency at time of correction of left sided valvular lesions. We recommend using such simple repair techniques to correct pure functional moderate to severe tricuspid regurgitation in association with the left sided valve corrective procedures to ensure easy post operative recovery and decrease the risk of reoperation. However we recommend follow up of such patients for a longer period of time to confirm the efficacy and durability of such procedures and find out the incidence of recurrence of severe tricuspid regurge and the incidence of reoperation

Pre-operative and operative factors affecting myocardial insult in cabag

We studied 49 patients who underwent coronary artery bypass. Surgery for their ischaemic heart disease was performed at As-Salam International Hospital. Forty-eight patients were males and only one female, those suffering from diabetes were 19 patients [38.78 percent] and also the same number were hypertensive. We used cold potassium cardioplegia [St. Thomas] as a method of myocardial preservation in 28 patients [77.5 percent], while intermittent ventricular fibrillation was used 1n 11 cases [22.4 percent]. There was no statistical difference between the two groups in the post operative rise or cardiac enzymes. We found also that bypass time in an important factor that determines the post operative need of cardiac support and post operative rise in enzyme CPK, the higher the bypass time the more the rise in CPK and the more the need for myocardial support