Minimal Access Tricuspid Valve Surgery

Abstract

Tricuspid valve diseases are a heterogeneous group of pathologies that typically have poor prognoses when treated medically and are associated with significant morbidity and mortality with traditional surgical techniques. Minimal access tricuspid valve surgery may mitigate some of the surgical risks associated with the standard sternotomy approach by limiting pain, reducing blood loss, lowering the risk of wound infections, and shortening hospital stays. In certain patient populations, this may allow for a prompt intervention that could limit the pathologic effects of these diseases. Herein, we review the literature on minimal access tricuspid valve surgery focusing on perioperative planning, technique, and outcomes of minimal access endoscopic and robotic surgery for isolated tricuspid valve disease.

Keywords: endoscopic and robotic cardiac surgery; minimal access surgery; tricuspid valve regurgitation.

Figure 1

An example of the typical setup for MATVS at the Lancashire cardiac centre. A periareolar skin incision is made with a mini-thoracotomy at the fourth intercostal space with a camera port at the same level (blue trocar). An additional trocar (grey) is placed to facilitate the installation of a cardiotomy succion and/or pericardial stay sutures.

Figure 2

Full cannulation setup. Of note, this case was done on a beating heart with a single venous cannula and no additional shunting or occlusion devices. Furthermore, a ‘Y’ arterial connection is routinely constructed to facilitate additional arterial cannulation if need be (doubly clamped arterial connection at the bottom of the image). The camera holder is a pneumatically operated arm which can be seen at the top of the image.