On Pump Beating Heart Minimally Invasive Tricuspid Valve Repair In The Redo Setting: Feasible/safe?
Amber Malhotra, MD, Md Anamul Islam, PhD, Giuseppe Tavilla, MD, PhD, Mustafa Baldawi, MD, Thomas A. DAmato, MD, Ramachandra C. Reddy, MD.
Baylor Scott & White Medical Center, Temple, TX, USA.
BACKGROUND: Tricuspid Regurgitation is a common residual, or a new lesion occurring at various intervals after the first surgery due to natural progression, mitral disease evolution, infective endocarditis, pacemaker leads etc. Given the prior functional cardiac compromise, possible flowing CAB grafts and dilated RA/RV in the redo setting, present significant challenges towards safe reentry and cardiac function preservation during the redo surgery.
METHODS: We present 3 patients who underwent this procedure at our center. With regular endotracheal intubation, these patients are placed in supine position. Anterolateral thoracotomy is done. Femorofemoral cannulation is achieved. Venous cannula is advanced into the SVC. The lung is freed from pericardium, but the pericardium doesn’t have to be separated from the RA. RA is opened with 2 drop in suckers which are positioned into the coronary sinus and near the svc orifice. The TV repair is carried out in routine fashion albeit with long instruments. Options to improve exposure include lowering the flows intermittently and fibrillating the heart.
RESULTS: Out of the three patients, two were female and one was male. The mean age and BMI were 61.67±13.5 years and 24.3±1.5, respectively. In-hospital survival rate was 100%. The mean length of hospital stay and intensive care unit were 13.33±4.5 and 6.12±3.15 days, respectively. The mean ventilation hours were 19.5±17.7. There was no post-operative bleeding, stroke, pulmonary complication, sepsis, GI bleeding, or atrial fibrillation in any of these three patients. One patient needed hemodialysis post-operatively.
CONCLUSIONS: TV Repair in a redo setting can safely be accomplished in a minimally invasive manner without jeopardizing the coronary conduits or causing dysfunction or risking strokes due to cross clamping of the aorta. Intuitively, the recovery is quick, complications are few, however the lack of a control group precludes a head-to-head comparison.
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