Should Moderate Functional Tricuspid Regurgitation Be Repaired During Surgery for Rheumatic Mitral Valve Disease?

BACKGROUND: Surgical repair of concomitant functional moderate tricuspid valve (TV) regurgitation at the time of mitral valve (MV) surgery remains controversial. AIM: The objective of this study was to evaluate the outcomes of concomitant repair of functional moderate tricuspid regurgitation (TR) during MV surgery for rheumatic valve disease. METHOD: From 1998 to 2016, 1,240 patients had rheumatic MV disease associated with moderate functional TR: 974 patients had MV surgery and concomitant TV repair (group 1) and 266 patients had MV surgery alone (group 2). Study endpoints were operative outcomes, rehospitalisation for congestive heart failure (CHF), and TV reintervention. Propensity score matching identified 192 well-matched pairs for outcomes comparison. RESULTS: Patients who had concomitant TV repair were younger (p=0.02) and there were fewer diabetics (p=0.015). In matched patients, low cardiac output was significantly higher in group 2 (p=0.044) and there was no difference in ventilation time, intensive care unit stay, cardiopulmonary bypass, and ischaemic times (p=0.480, p=0.797, p=0.232, and p=0.550, respectively) between groups. Patients in group 2 required more TV reintervention (1 vs 35 in group 1 and 2, respectively; p=0.004) and rehospitalisation for CHF (5 vs 40 in group 1 and 2, respectively; p<0.001). CONCLUSIONS: Concomitant TV repair for moderate TR in patients undergoing rheumatic MV surgery was not associated with increased operative risk. Postoperative low cardiac output syndrome and the risk of late TV reinterventions and rehospitalisation for CHF were lower with TV repair. Concomitant repair of the moderate TV regurgitation maybe beneficial for patients undergoing rheumatic MV surgery.

Bilateral Ultrasound-Guided Erector Spinae Plane Block for Management of Acute Postoperative Surgical Pain After Pediatric Cardiac Surgeries Through a Midline Sternotomy.

BACKGROUND: Ultrasound (US) guided erector spinae plane block (ESPB) is a safe and effective technique in providing perioperative pain management in pediatrics with a high success rate. THE AIM OF THIS STUDY: Was to compare the efficacy of bilateral ultrasound-guided erector spinae plane block for management of acute postoperative surgical pain after pediatric cardiac surgeries through a midline sternotomy. METHODS: One hundred patients aged 4-12 years were randomly assigned into two groups, both groups received general anesthesia followed by bilateral sham erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg normal saline on each side in the control group (group C) or bilateral ultrasound-guided erector spinae plane block at the level of T6 transverse process using 0.4 ml/kg ropivacaine 0.2% with a maximum dose of 2 mg/kg mixed with adrenaline 2 mcg/ml in erector spinae plane block group (group E). The postoperative pain scores were evaluated immediately post-extubation, at 1 hour, 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, and 24 hours after extubation, total consumption of intraoperative fentanyl and time to first rescue analgesic administration were also recorded. RESULTS: There was a statistically high significant delay in the group E (314.72 ± 45.94) compared with the group C (36.7 ± 7.22) as regards to the mean (SD) of the time of the rescue analgesia (P < 0.001) (with 95% CI), moreover; the number of rescue analgesic was significantly higher in the group C compared with the group E (P < 0.001) (with 95% CI) and the mean (SD) of total intraoperative and postoperative levels fentanyl requirements in the group C were significantly higher compared with the group E (6.47 ± 0.98 and 5.09 ± 0.83) (with 95% CI) in group C versus (4.69 ± 0.71 and 2.31 ± 0.66) (with 95% CI) in group E respectively (P < 0.001) (with 95% CI). CONCLUSION: Ultrasound-guided bilateral ESPB with ropivacaine and adrenaline delays the postoperative need of analgesia and reduces postoperative fentanyl consumption at 24 h in pediatric patients undergoing cardiac surgery through midline sternotomy.