BACKGROUND: Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy. METHODS: We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n = 26) and compared them to redo-Sternotomy (n = 17). A group of primary-MITS (n = 61) served as control. RESULTS: The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo-Sternotomy: 8.42 ± 7.33% versus primary-MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo-MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR] = 9.76; 95% confidence interval [CI] 1.88-63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20-54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02-1.35) as independent predictors of 30-day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR] = 2.67; 95% CI 1.18-6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45-7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04-4.92) as risk factors for poor long-term survival. TV surgery significantly reduces NYHA class. CONCLUSION: Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome. Georg Thieme Verlag KG Stuttgart · New York.
BACKGROUND: Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy. METHODS: We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n = 26) and compared them to redo-Sternotomy (n = 17). A group of primary-MITS (n = 61) served as control. RESULTS: The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo-Sternotomy: 8.42 ± 7.33% versus primary-MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo-MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR] = 9.76; 95% confidence interval [CI] 1.88-63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20-54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02-1.35) as independent predictors of 30-day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR] = 2.67; 95% CI 1.18-6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45-7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04-4.92) as risk factors for poor long-term survival. TV surgery significantly reduces NYHA class. CONCLUSION: Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome. Georg Thieme Verlag KG Stuttgart · New York.
Authors: Mahima Vijayaraghavan; Kurt W Prins; Sasha Z Prisco; Sue Duval; Ranjit John; Stephen L Archer; E Kenneth Weir; Rochus Voeller; Andrew W Shaffer; Thenappan Thenappan Journal: CJC Open Date: 2020-12-16
Authors: Akram Kawsara; Fahad Alqahtani; Vuyisile T Nkomo; Mackram F Eleid; Sorin V Pislaru; Charanjit S Rihal; Rick A Nishimura; Hartzell V Schaff; Juan A Crestanello; Mohamad Alkhouli Journal: J Am Heart Assoc Date: 2021-01-05 Impact factor: 5.501