Minimally Invasive Tricuspid Valve Surgery Following Previous Cardiac Surgery
Kazimierz J. Widenka1, Nikodem Stożyński2, Maciej Kolowca1, Piotr Olszówka1, Bogusław Gawęda1, Beata Horeczy1, Piotr Suwalski3.
1Uniwersytet Rzeszowski, Rzeszów, Poland, 2Kliniczny Szpital Wojewódzki nr 2, Rzeszów, Poland, 3Central Clinical Hospital of the Ministry of Interior and Center of Postgraduate Medical Education, Warsaw, Poland.
Background: The surgical management of tricuspid valve replacement after previous cardiac surgery is associated with increased mortality & morbidity. New methods of percutaneous & minimally invasive approaches are not widely accepted. The aim of the study was to evaluate short & midterm results of minimally invasive tricuspid valve surgery in high risk patients. Methods: 44 patients who between November 2008 and December 2019 were operated for severe tricuspid regurgitation, following previous cardiac surgery were retrospectively analysed. Mean age of the patients was 66.9±8.18 years, 37 were female. All patients had previous cardiac operations 33 mitral, 6 mitral & aortic, 2 aortic & 3 coronary surgery. 39 patients underwent mitral valve repair & 5 replacement. Average preoperative NYHA functional class was 3.03±0.50, 36 had persistent & 4 paroxysmal atrial fibrillation. The operation was performed via right minithoracotomy with peripheral cannulation on beating heart without cardioplegia. Results: The mean cardiopulmonary bypass time, ventilation time & postoperative hospital stay was 67.3±41.81 min, 12,0±202.89 hrs & 13.7±13.10 days, respectively. 4 patients were reopened for bleeding, 2 required haemodialysis & 1 pacemaker implantation, 2 developed lymphocele. The average transfusion rate was as follows: blood units 2.63±3.42, FFP units 2.45±3.42, US platelets units 1.75±4.88. The median drainage was 545±745.43 ml. The overall 30 day mortality was 4.5%, including one patient that developed stroke & eventually died. Average follow up was 3.6±3.22 years. During follow up 10 (22.7%) patients died. The average NYHA functional class post operatively was 1.7±0.78. 19 patients were off diuretics following operation, as oppose to all on diuretics preoperatively. Conclusions: Minimally invasive tricuspid valve operation following previous cardiac surgery is feasible & safe, with law mortality & morbidity. The long term results are less satisfactory due to end stage heart failure upon referral. In view of law operative mortality earlier referral for tricuspid valve surgery should be advocated.
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