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Minimally Invasive Redo Surgery for Late Isolated Tricuspid Valve Regurgitation
Giacomo Bianchi, Marco Solinas, Pierandrea Farneti, Matteo Ferrarini, Mattia Glauber.
Hospital & Research Institute CREAS IFC CNR - Massa - G.Pasquinucci Heart Hospital, Massa, Italy.

OBJECTIVE: tricuspid valve (TV) regurgitation after left-sided-valve surgery is likely to occur and progress over time, requiring surgical intervention and negatively affects survival and prognosis. We analyzed the outcome of a consecutive series of patients at our institution that underwent isolated redo isolated tricuspid valve procedure.
METHODS: between January 2005 and January 2012, a total of 59 patients underwent isolated tricuspid valve surgery; of those 13 (22%) patients (2 males, 11 females; mean age 65,5±7,7 years) underwent redo procedure for new-onset tricuspid regurgitation (TR) through right lateral mini-thoracotomic approach. The preoperative left ventricular ejection fraction was 56%±12%; the thirteen patients underwent a total of 19 previous cardiac operations for left-sided valve pathology. Tricuspid regurgitation progressed from grade ≤2+/4+ to 4+/4+ until surgery in 204±134 months. Preoperative NYHA class was grade ≥III in 9 (69%) patients.
RESULTS: ten patients (77%) had TV repair and three patients had TV replacement. TR decreased from grade 3,85±0,55 to 0,92±0,7 (p≤0,001) as well as pulmonary artery pressure (PAPs; 51,5±18,9 mmHg vs 37,9±10,2 mmHg, p=0,02) postoperatively. One patient (7,7%) died in-hospital for low cardiac output syndrome. The mean follow-up was 15±13 months and was 100% complete. Survival and freedom from HF symptoms were 91,7% (95% CI: 30-43) and 83,3% (95% CI: 26-41) at 40 months, respectively; NYHA class ≤IIb was found in 81,8% of patients were in. At follow up the PAPs remained as low as at post-operative assessment (p=0.6).
CONCLUSIONS: redo procedure for isolated TR is a feasible and effective procedure with acceptable in-hospital mortality. High survival rate and freedom from symptoms are associated with stable decrease of PAPs, TR grade and improvement of NYHA class.


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