Minimally Invasive Isolated Tricuspid Valve Surgery Experience at a Single Centre

Background: Tricuspid valve disease has been steadily increasing, raising concerns about the morbidity and mortality associated with surgery when performed via conventional sternotomy. In this context, the clinical and aesthetic advantages of isolated tricuspid surgery by right anterior mini-thoracotomy without aortic clamping are presented.

Methods: A case series of 29 patients who underwent minimally invasive isolated tricuspid valve surgery in our center, from 2014 to 2023, have been studied retrospectively. The operation was performed by right anterior mini-thoracotomy without caval exclusion and without aortic clamping to a beating heart assisted by 3D videothoracoscopy. Preoperative levosimendan was administered in 22 patients with severe pulmonary hypertension and/or right ventricular dysfunction. 

Results: 28 tricuspid valve replacement and one repair were performed. Average patients age was 63 years old (SD 8). 18 patients (62%) had previous cardiac surgery. 22 patients (75,8%) had severe pulmonary hypertension and 12 (41,3%) had right ventricule disfunction. Average EuroSCORE II was 4,10%. In-hospital mortality was 3,4% (one patient). The average extracorporeal circulation was 109 minutes (SD 41). There was a reoperation due bleeding and a permanent pacemaker implantation in the fourth postoperative day (3,4%). Temporary renal replacement therapy was required in 21% (6 patients). The median length of hospital stay was 7 days.

Conclusions: Minimally invasive isolated tricuspid valve surgery is a safe technique as a definitive treatment of isolated tricuspid valve disease with a low mortality and morbidity.

KEY POINTS:

3D VIDEO-ASSISTED TRICUSPID VALVE SURGERY IN A BEATING HEART

RIGHT MINITHORACOTOMY IS ASSOCIATED WITH FASTER RECOVERY INCLUDING REDO PATIENTS

DELAY IN TRICUSPID REGURGITATION SURGERY HAS NO BENEFITS

PREOPERATIVE LEVOSIMENDAN IMPROVES RIGHT VENTRICLE AND PULMONARY HYPERTENSION ECHO PARAMETERS

MINIMALLY INVASIVE TRICUSPID VALVE SURGERY IS SAFE AND EFECTIVE