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. 2020 Jan/Feb;15(1):66-73.
doi: 10.1177/1556984519887946. Epub 2020 Jan 5.

Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option

Abdelrahman Abdelbar  1 , Gunaratnam Niranjan  1 , Charlene Tynnson  1 , Palanikumar Saravanan  2 , Andrew Knowles  2 , Grzegorz Laskawski  1   3 , Joseph Zacharias  1
Affiliations

Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option

Abdelrahman Abdelbar et al. Innovations (Phila). 2020 Jan/Feb.

Erratum in

Abstract

Objective: Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery.

Methods: In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery (n = 24). Of these patients, 13 (54%) had more than one previous sternotomy.

Results: Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months.

Conclusions: Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.

Keywords: endoscopic tricuspid surgery; endoscopic valvular surgery; tricuspid valve disease.

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