Elsevier

The Annals of Thoracic Surgery

Volume 94, Issue 6, December 2012, Pages 2005-2010
The Annals of Thoracic Surgery

Original article
Adult cardiac
Isolated Reoperative Minimally Invasive Tricuspid Valve Operations

https://doi.org/10.1016/j.athoracsur.2012.06.064Get rights and content

Background

Tricuspid valve (TV) regurgitation has recently been identified as a major risk factor for long-term mortality. Isolated reoperative tricuspid valve repair/replacement (TVR/r) carries an excessively high operative risk. Currently, isolated TVR/r with minimally invasive access through a right lateral thoracotomy is being used increasingly in our institution to treat progressive TV pathologic processes after previous cardiac operations. We analyzed our early and midterm results with reoperative TVR/r in this unique patient cohort.

Methods

Forty-eight consecutive patients underwent isolated TV operations after previous cardiac operations with minimally invasive access through a right lateral thoracotomy at our institution between September 2000 and December 2011. Previous cardiac operations included 26 patients (54.2%) with mitral valve replacement/repair, 18 patients (37.5%) with an aortic valve replacement, 10 patients (20.4%) with a TVR/r, and 8 patients (16.7%) with coronary artery bypass grafting. Operations were performed electively in 79% of patients (n = 38). Mean patient age was 63.8 ± 13.4 years, with an average log EuroSCORE of 13.9% ± 11.3%; 67% of patients were women. Follow-up was 94% complete, with a mean duration of 2.8 ± 2.3 years.

Results

Thirty-day mortality for patients undergoing elective surgery was zero. For all patients early mortality was 4.2%. Five-year survival for patients after elective reoperative TVR/r through minimally invasive access was 72.2% ± 10.0%, and 5-year freedom from TV-related reoperations was 88.1% ± 6.7%, respectively.

Conclusions

Minimally invasive access through a right thoracotomy provides a safe option for reoperative TVR and offers excellent early outcome, particularly in elective cases. Surgical intervention should be performed earlier rather than later.

Section snippets

Patients and Methods

We report on our retrospective analysis of 48 consecutive patients who underwent isolated reoperative TVR/r performed through a limited right lateral thoracotomy using a minimally invasive operative technique at our institution between September 2000 and December 2011. Ethics approval for this retrospective study was granted by the local ethics committee. Individual patient consent was not required.

All patients presented after previous cardiac operations: 26 patients (54.2%) had previously

Results

Forty-eight consecutive patients with severe TR (mean age, 63.8 ± 13.4 years; range 22–83 years; 67% women) underwent reoperative procedures for isolated TVR/r with minimally invasive access through a right lateral thoracotomy between September 2000 and November 2011.

Demographic data are depicted in Table 2. Left ventricular function was normal in 56.2% ± 10.6% of patients, 22 patients (45.8%) suffered from atrial fibrillation, and 16 patients (33.3%) were men. Mean pulmonary artery pressure

Comment

Our experience with this patient series suggests that patients undergoing elective isolated TV reoperations with a minimally invasive approach experience excellent early outcomes and 5-year survival of 72.2% ± 1.0%. After urgent reoperative TVR/r, however, early mortality is higher and longevity is less favorable, with a 5-year survival of only 42.0% ± 17.6%. The latter corresponds to the predicted 5-year survival of approximately 40% in patients who do not undergo operation [11].

We believe the

References (20)

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Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.