Addition Of Tricuspid Valve Intervention To Minimally Invasive Mitral Valve Surgery Insights From Single Centre Experience
Mariusz Kowalewski, Radosław Smoczyński, Jakub Staromłyński, Anna Witkowska, Mariusz Kujawski, Maciej Bartczak, Michał Pasierski, Dominik Drobiński, Piotr Suwalski.
CSK MSWiA, Warsaw, Poland.
BACKGROUNDMinimally invasive mitral valve (MIMVS) surgery has become widely accepted alternative to standard sternotomy approach for the treatment of complex MV disease. As many as up to 40% of MIMVS undergoing patients have indications to tricuspid valve intervention (repair [r] or replacement [R]). Yet, to date intervention to tricuspid valve (TVr or TVT) has been feared as unnecessary prolonging the operative time, complicating the surgery, and is often abandoned, in turn leading to patients’ postoperative deterioration due to right heart failure. METHODSBetween 2011 and 2018, 388 patients underwent minimally invasive mitral valve- and mitral and tricuspid valve surgery via minithoracotomy. All patients that required TVr or TVR were treated; only endocarditis cases were excluded. No further exclusion criteria as of surgical status were imposed. TVr and TVR were performed in “on-pump beating heart” mode. Right mini-thoracotomy was performed through a 4.0 to 6.0-cm skin incision in the fourth or fifth intercostal space depending on preoperative imaging. From 2015 forward, 3.5 to 4.0-cm periareolar access was adopted. Demographics and clinical outcomes were collected and reported. Kaplan-Meier estimates of survival have been analysed at short term (30 days) and longest available follow-up.RESULTSMedian follow-up was 2.5 years (max 8.0 years). Of all patients undergoing MIMVS, 121 (31.2%) required TVr/TvR. 221 patients (57.0%) were male; aged 64.5+/-11.5, with EuroSCORE II of 2.71+/-3.84. Mitral valve repair was preferred approach that ensued in 294 (75.8%) of cases. MV replacement in 94 (24.2%). PTFE loops and annuloplasty rings were used in all MV repair cases. Cardiopulmonary bypass time was 166.0+/-52.3 minutes in MIMVS + TVr/TVR group and 157.6+/-67.5 minutes in MIMVS alone (P=0.225). Median duration of intensive care unit stay was 3.0 [IQR: 1.9-5.8] days. 30-day survival was no different between the two groups: Hazard Ratio: 0.54; 95% Confidence Intervals (0.16-1.81); P=0.319, and so was long term estimate: 0.99 (0.53-1.86); P=0.985. Figure 1.CONCLUSIONSThe study proved that minimally invasive mitral and tricuspid valve surgery performed through mini-thoracotomy incision are feasible. Addition of tricuspid intervention non significantly adds to CPB duration and has no effect on both short- and long-term mortality. 
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