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Concomitant tricuspid annuloplasty in patients with minimally invasive mitral valve repair
Yuta Akamatsu, Kazuma Okamoto, Mikihiko Kudo, Akihiro Yoshitake, Mio Kasai, Akinori Hirano, Ichiro Kashima, Ryo Aeba, Hideyuki Shimizu.
KEIO hospital, Tokyo, Japan.

OBJECTIVE: In recent years, we have actively performed concomitant tricuspid annuloplasty (TAP) in mitral valve plasty (MVP) via right mini- thoracotomy in case that tricuspid regurgitation (TR) is moderate or severe, tricuspid annulus is enlarged, with atrial fibrillation, or/and pulmonary hypertension. The aim of this study is to investigate short-term outcomes of concomitant TAP in right mini-thoracotomy setting.
METHODS: Between November 2011 and December 2015, 29 patients (mean age 54.4 ± 11.8 years, male n=20) who underwent MVP and TAP via right mini-thoracotomy were retrospectively summarized. In same period, 110 patients (mean age 49.5 ± 13.0 years, male n=80) underwent MVP without TAP. Annuloplasty ring was used for TAP.
RESULTS: 30-days mortality for MVP with TAP was 0%, and the length of postoperative stay in hospital was 13 ± 8 days. Only 1 patient had major complications with re-expansion pulmonary edema that needed VV extracorporeal membrane oxygenation and tracheotomy. 13 (45%) patients required blood transfusion. Operative time, total pump time, and aortic cross-clamp time was 350.9 ± 73.9, 245.0 ± 68.4, and 172.6 ± 50.9, respectively. On the other hand, 30-days mortality for MVP without TAP was 0%, and the length of post operative stay in hospital was 15 ± 22 days. 42 (38%) patients required blood transfusion. Operative time, total pump time, and aortic occlusion time was 338.3 ± 75.5, 239.1 ± 67.1, and 167.4 ± 54.2, respectively. Pre and post operative TR were 1.93 ± 0.53 and 1 ± 0.53 by transthoracic echocardiography.
CONCLUSIONS: There is no significant difference in operative time, the length of postoperative stay, and blood transfusion, and there is significant difference in TR between pre and post TAP. Concomitant TAP with MVP via mini-thoracotomy was safely added without signify elongation of procedural time and additional risk. Even in mini-thoracotomy setting, concomitant TAP should be added aggressively, if it is indicated.

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