ISMICS 2023 Annual Meeting

Minimally Invasive and Robotic Approaches to Mitral and Tricuspid Endocarditis are Safe and Effective

George Comas MD, J Hunter Mehaffey MD MSc, Elwin Tham MD, Ali Darehzereshki MD, Lawrence Wei MD, Vinay Badhwar MD

Department of Cardiovascular and Thoracic Surgery, West Virginia University

Introduction

The 2016 AATS consensus guidelines on surgical treatment 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 and robotic approaches to mitral valve (MV) and tricuspid valve (TV) endocarditis.

Methods

Queried our Institutional Society of Thoracic Surgeons Adult Cardiac Database for all patients with MV and/or TV endocarditis undergoing minimally invasive or robotic valve surgery via right thoracic approach between July 1, 2016 and June 30, 2022

Excluded Concomitant procedures

Stratified patients by valve location

Compared Descriptive statistics by valve and approach (repair vs replacement)

Results

A total of 48 patients underwent minimally invasive or robotic surgery for mitral or tricuspid endocarditis during the study period.

Preoperatively,

20 patients (37.5%) had HF (MV=16, TV=4)

3 patients (6.3%) were on dialysis (MV=2, TV=1)

3 MV patients had an acute stroke prior to operation

Median BMI was 26.4 [19.6-44.8] kg/m2

Active endocarditis was present in 65% patients (31/48)

Intraoperatively,

Robotic approach was globally 46% (22/48), all MV with no conversion to sternotomy

Repair rate for MV endocarditis was 80% (24/30)

Annuloplasty ring utilized in 54% patients (13/24)

Autologous pericardial patch in 21% patients (5/24)

Ipsilateral chordal transfer in 83% patients (20/24)

Repair rate for TV endocarditis was 38.9% (7/18) with 1 conversion to open sternotomy.

Annuloplasty ring utilized in 57% patients (4/7)

Autologous pericardial patch in 57% patients (4/7)

Institutional global repair rate for:

MV endocarditis: 49.3%

TV endocarditis: 47.3%

Postoperatively,

No operative mortalities, new strokes, new renal failure, or wound infections.

2 reoperations for bleeding (all MV) and 4 patients with prolonged ventilation (3 MV, 1 TV).

Conclusion

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.

ISMICS 2023 Annual Meeting

Minimally Invasive And Robotic Approaches To Mitral And Tricuspid Endocarditis Are Safe And Effective

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