Endoscopic Cardiac Approach For Isolated Tricuspid Valve Surgery Without Patients Selection
Giovanni Domenico Cresce, Tommaso Hinna Danesi, Antonio Cammardella, Alessandro Favaro, Paolo Magagna, Massimo Sella, Loris Salvador.
San Bortolo Hospital, Vicenza, Italy.
BACKGROUND: Isolated tricuspid valve (TV) surgery is considered a high risk operation with poor postoperative outcomes. Aim of this study was to report our experience on isolated TV surgery performed through an endoscopic cardiac approach and to assess early and medium term outcomes with regard to the surgical technique.
METHODS: From January 2010 to December 2016, 47 consecutive patients (mean age 65±14.2 years, 26 females, Mean EuroScore II 4.03±8.39) underwent isolated TV surgery at our Institution. Indication for surgery were: symptomatic severe TV regurgitation, TV endocarditis and Ebstein's anomaly in 39, 4 and 4 cases respectively. Twenty-eight patients (59.6%) were preoperatively in NYHA functional class III/IV. Twenty patients (42.5%) had a previous cardiac operation. In all patient the surgical access was an anterior mini-thoracotomy with a periareolar access in males and a completely endoscopic video-guided approach. Follow-up was 100% complete with a mean duration of 32±22.3 months.
RESULTS: All patients underwent TV surgery as a single valve procedure. Among them, 31 had a valve repair and 16 a valve replacement. In 32 cases (68%) the operation was performed with the heart beating. Overall in-hospital mortality was 6.3% (3 patients). In patients underwent TV repair and TV replacement it was 0 and 18.7% respectively (p=0.03). Twelve months, 24 months and 83 months survival were 86.8% (95% CI= 73-93.8%), 81% (95% CI= 65.3-90.1%) and 77.7% (95% CI = 60.9-87.9%) respectively. At follow-up, 94.4% of patients were in NYHA functional class I or II. Freedom from reoperation was 100%. Pre-operative NYHA class III/IV, BPCO, Endocarditis and TV replacement were found the independent predictors of survival for all isolated TV operations.
CONCLUSIONS: Endoscopic cardiac surgery provides a safe surgical option even in this cohort of high-risk patients undergoing isolated TV surgery. In the present study, pre-operative NYHA functional class III/IV and TV replacement appear to determine prognosis. It suggests that the timing of the surgical therapy should be anticipated.
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