Safety And Outcomes Of Re-operative Robotic Tricuspid Valve Surgery
Panos Vardas, James West, Gagandip Singh, Rongbing Xie, Richard Stephens, Clifton Lewis.
UAB, Birmingham, AL, USA.
Background:Isolated redo tricuspid valve replacement or repair (TVR/r) carries a high operative risk for morbidity and mortality. Robotic assisted re-operative TVR/r is a not a very common operation and has been previously studied. We report the early outcomes for a large series of isolated redo robotic tricuspid valve surgery. Methods:The institutional STS Adult Cardiac Surgery Database was used to identify patients with previous cardiac procedure(s) undergoing isolated robotic TVR/r from 09/2017 to 10/2022. Twenty-four consecutive patients underwent robotic isolated redo TVR/r for primary (n-9, 38%) or secondary (n-15, 62%) tricuspid valve pathology. For the majority this was a second reoperation (92%), while for 8% of patients was the third reoperation (Table 1). Mean patient age was 71.8 ± 12.6; 62.5% of patients were women. Most patients had an LVEF>45% (58.3%) versus 33.3% with an LVEF 35-45% and 8.3% <35%. Primary outcome was 30-day mortality, while secondary outcomes consisted of 30-day readmission rate, reintervention rate, length of stay, need for permanent pacemaker and other adverse events. We developed descriptive statistics and we examined the different outcomes on primary versus secondary etiology using bivariate analysis. Results:Thirty-day mortality was 8.3 % for entire cohort (2 patients with secondary disease died from respiratory complications). The operation was performed with beating heart for the entire cohort and the average cardiopulmonary bypass time was 60.1 ± 18.8 minutes (74.2 min for the sub-group with primary disease versus 51.6 min for those with secondary disease). Twenty patients underwent TVr versus four TVR (porcine bio-prosthesis was used on all of them). One patient underwent concomitant PFO closure during TVr. There was no conversion to open procedure for the entire series. There was no incidence of post-operative permanent pacemaker placement. The rate of reintervention was 8.3 % (bleeding). Major complications were respiratory failure (need for prolonged ventilation - 12.5%) and renal failure (8.3%). The readmission rate was low (4.5%) (Table 1) Conclusions:In this series isolated robotic re-operative tricuspid valve surgery was safe with good early post-operative outcomes. Pre-operative respiratory risk stratification is important for this patient population given the severity of pulmonary complications. To our knowledge, this is the largest series reported on robotic assisted redo tricuspid valve surgery.
Table 1: Post-operative outcomes and spectrum of previous cardiac procedures
| Post-operative Outcomes | Overall (n=24) | Primary (n=9) | Secondary (n=15) | p-value |
| 30-day mortality | 2 (8.3%) | 0 (0.0%) | 2 (13.3%) | 0.1515 |
| PPM insertion | 0 (0%) | 0 (0%) | 0 (0%) | . |
| Re-intervention | 2 (8.3%) (both bleeding) | 0 (0.0%) | 2 (13.3%) | 0.1515 |
| Respiratory failure | 3 (12.5%) | 1 (11.1%) | 2 (13.3%) | 0.8734 |
| Renal failure | 2 (8.3%) | 1 (11.1%) | 1 (6.7%) | 0.7029 |
| Length of stay (day) | 10.4 ± 7.0 | 8.7 ± 5.9 | 11.4 ± 7.6 | 0.3661 |
| 30-day readmission | 1 (4.5%) | 0 (0.0%) | 1 (7.7%) | 0.3944 |
| Previous Cardiac Procedure | Robotic TV Procedure | Frequency (n=24) |
| Redo AVR, s/p AVR/MVR | 3rd Cardiac Re-operation | 1 (4.1%) |
| TVR and myxoma removal, s/p MAZE | 3rd Cardiac Re-operation | 1 (4.1%) |
| AVR/MVR | 2nd Cardiac Re-operation | 2 (8.3%) |
| CABG | 2nd Cardiac Re-operation | 6 (25.0%) |
| MVR | 2nd Cardiac Re-operation | 6 (25.0%) |
| MVR/CABG | 2nd Cardiac Re-operation | 3 (12.5%) |
| MVR/TVR/CABG | 2nd Cardiac Re-operation | 1 (4.1%) |
| Sinus Venosus ASD repair | 2nd Cardiac Re-operation | 1 (4.1%) |
| TV Replacement | 2nd Cardiac Re-operation | 1 (4.1%) |
| TV Repair | 2nd Cardiac Re-operation | 1 (4.1%) |
| TV valvotomy for tumor resection | 2nd Cardiac Re-operation | 1 (4.1%) |
PPM- permanent pacemakerAVR- Aortic Valve ReplacementMVR- Mitral Valve ReplacementTVR- Tricuspid Valve ReplacementCABG- Coronary Artery Bypass GraftASD- Atrial Septal Defects/p- status post
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