Video-assisted Tricuspid Valve Repair Through Minithoracotomy With A Simplified Technique
Marco Diena, Gheorghe Cerin, Luca Renzi, GianLuca Martinelli.
Cardioteam Foundation. San Gaudenzio Clinic, Novara, Italy.
Background. Minimally invasive tricuspid valve repair is often cumbersome for its anatomical position and the difficulties to snare both Caval veins through the small incision. Here we describe how to approach the tricuspid valve via right minithoracotomy without snaring the caval veins with a single venous cannulation and video-endoscopic assistance. Methods. A single two stage venous cannulation is inserted percutaneously at the groin under echo guidance taking care to position its holes in superior and inferior caval veins. Extracorporeal circulation i started from the venous cannula and an aortic or femoral cannula. Concomitant to mitral surgery or as isolated procedure we stop the vacuum active drainage from the pump to avoid entering air into the circuit. Opening the right atrium as usual the venous cannula should lay down below the blood surface on the inferior aspect of the cavity. Pulling up the tricuspid valve by two stay sutures we proceed to repair the valve under direct or endoscopic vision.Results. On 334 consecutive patients with mitral regurgitation scheduled for a minithoracotomy, 56 (17%) had a severe tricuspid regurgitation or an enlarged anulus greater than 21mm indexed and were operated on the tricuspid valve with this technique. We had no mortality. Il all cases we could repair the tricuspid valve in cross clamping with good results except one case discharged with a residual moderate insufficiency.Conclusions. Tricuspid valve repair through minithoracotomy may be cumbersome if a very small incision is used at the time of caval snaring.This simplified technique avoiding to encircle both vene cave and with video assistance allows an easier procedure and reduce the risk of injuries at this level. A strict cooperation between surgeon and perfusionist is mandatory to adjust the pump flow during the opening of the right atrium.
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