International Society For Minimally Invasive Cardiothoracic Surgery

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Is Endoscopic Isolated Tricuspid Surgery A Safe Approach?
Gunaratnam Niranjan, Charlene Tennyson, Ahmed Habib, Palaniqumar Saravanan, Andrew Knowles, Grzegorz Laskawski, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.

Background Tricuspid valve (TV) surgery is usually performed as a concomitant reconstruction procedure in addition to the correction of other cardiac pathologies. Isolated tricuspid valve surgery has been associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, and outcomes have not been well described, with results often contradictory. We present our experience of endoscopic isolated tricuspid valve surgery. Methods At our institution we have undertaken over 75 endoscopic tricuspid procedures either as a concomitant procedure or in isolation. Between December 2008 and August 2018, isolated tricuspid valve surgery using an endoscopic minimally invasive technique was performed in 19 patients (6 male, 13 female; mean age, 63.8 12.6 years). Mean preoperative logistic euroscore was 12 13 (median 7.3). Tricuspid valve regurgitation aetiology was functional in 17 patients (89%) and endocarditis related in 2 patients (11%). 9 patients (48%) had undergone previous cardiac procedures (5 valve, 2 CABG and 2 other). Data was looked at retrospectively using a prospectively collected database. Results Tricuspid valve repair was performed in 14 patients (74%) with the remaining 5 (26%) having bioprosthetic tricuspid valve replacement. 2 (11%) were done with beating heart, the remaining with intravascular clamping and cardioplegia. There were no conversions to sternotomy. No patients had re-operations for bleeding, tamponade or valve issues. Only 2 patients (11%) required blood transfusion. There were no new neurological events. 2 patients (11%) required renal dialysis. 5 patients (26%) had respiratory complications in the form of chest infection, requiring CPAP and 2 being re-intubated. One patient (5%) died predominantly due to chest sepsis leading to multi-organ failure. The mean hospital stay was 9.3 5.2 days, with a median of 8. Actuarial survival 8.9 0.8years. Conclusions Isolated TV surgery can be performed through an endoscopic minimally invasive approach, with good results. A high repair rate can be achieved safely, and the procedure has been particularly valuable in redo surgery.

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