Minimally Invasive And Robotic Approaches To Mitral And Tricuspid Endocarditis Are Safe And Effective
George Comas, J. Hunter Mehaffey, Elwin Tham, Ali Darehzereshki, Lawrence Wei, Vinay Badhwar.
West Virginia University, Morgantown, WV, USA.
BACKGROUND: Societal guidelines for the management of endocarditis advocate for a conventional sternotomy approach for valve repair or replacement. We sought to evaluate the repair rate and outcomes in patients undergoing minimally invasive or robotic valve surgery for endocarditis.
METHODS: Our institutional Society of Thoracic Surgeons Adult Cardiac Surgery Database was queried for all patients with mitral valve (MV) and/or tricuspid valve (TV) endocarditis undergoing minimally invasive or robotic valve surgery via a right thoracic approach between July 1, 2016 and June 30, 2022. After excluding concomitant procedures, patients were stratified by valve location. Descriptive statistics compared groups by valve, approach, and repair vs replacement.
RESULTS: A total of 48 patients underwent minimally invasive or robotic surgery for mitral or tricuspid endocarditis during the study period. Preoperative heart failure was present in 44% of patients (MV=17, TV=4), 3 patients were on dialysis (MV=2, TV=1), and 3 MV patients had an acute stroke prior to operation. Median body mass index was 26.4 kg/m2 (range 19.6-44.8) and intravenous drug use was implicated in the etiology of endocarditis in 66.7% (32/48). The repair rate for MV endocarditis was 80% (24/30) and the repair rate for TV endocarditis was 38.9% (7/18) with one conversion to open sternotomy. Robotic approach was utilized in 26 patients (all MV), 91.7% (22/24) had an annuloplasty ring, 33.3% (8/24) required an autologous pericardial patch, and 29.2% (7/24) underwent robotic ipsilateral chordal transfer, with no conversions to sternotomy. There were no operative mortalities, new strokes, new renal failure, or wound infections. Perioperative morbidity included 3 reoperations for bleeding (all MV) and 4 patients who required prolonged mechanical ventilation (3 MV, 1 TV).
CONCLUSIONS: Minimally invasive valve surgery is safe and effective for management of Mitral and Tricuspid endocarditis with a high rate of successful valve repair. Future guidelines and consensus statements should support open or minimally invasive approaches based on surgeon experience and expertise.
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