International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Triple Valve Surgery: A Single Center Experience
Michael G. Moront, MD, Michael Kuehne, PAC, PhD, Roberta E. Redfern, PhD.
ProMedica Toledo Hospital, Toledo, OH, USA.

Objective: Minimally invasive surgery is a widely accepted surgical treatment for valve disease, however triple valve surgery (TVS) is a complex and challenging procedure with longer bypass times, increased morbidity, and mortality rates approaching 25%. The objective of this study was to determine the morbidity and mortality rate of minimally invasive TVS utilizing a right anterior thoracotomy incision with femoral arterial and venous cannulation at our institution. Methods: This was a retrospective review of all minimally invasive triple valve surgeries performed between 2012 and 2018. Operative times, length of stay (LOS), complications, and mortality were analyzed. Results: Thirteen patients underwent TVS. The average age was 70.4 11.2 years; 7 (53.9%) were male. All patients had bioprosthetic aortic valve replacement with tricuspid valve ring annuloplasty; 10 underwent mitral valve replacement while 3 required mitral valve repair. Five patients underwent Bi-atrial Maze procedure, 7 had ligation of the left atrial appendage. Three patients underwent additional procedures at the time of TVS. The median cardiopulmonary bypass time was 166 minutes (IQR 154 - 175) and mean crossclamp time was 126.4 21.4 minutes. Median time to initial extubation was 11.5 hours (IQR 9.8 - 13.3). ICU LOS was 1.22 (IQR 1.16 - 1.31) days and total LOS was 9 days (IQR 6 - 17). There were no hospital deaths and 30-day mortality was 0%. No postoperative neurologic complications occurred, while in 2 patients (15.4%) acute kidney injuries were observed. The most common complication postoperatively was rhythm disturbance occurring in 7 patients, 5 of which required permanent pacemaker implantation. One patient required post-cardiopulmonary bypass sternotomy for repair of an iatrogenic left ventricular apical perforation. A second patient required veno-arterial ECMO for unilateral re-expansion pulmonary edema and evacuation of a right hemothorax postoperatively. Mean follow-up was 32 months (32 - 2219 days) with one non-cardiac mortality at 3.4 years. Conclusions: Our findings demonstrate that minimally invasive triple valve surgery utilizing femoral cannulation results in an acceptable risk of complication and that both short and intermediate term survival were excellent.

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