Benefits of a right anterolateral minithoracotomy rather than a median sternotomy in isolated tricuspid redo procedures

Abstract

Background:To compare results of tricuspid valve (TV) reoperation between incision via a right anterolateral minithoracotomy (RAMT) and median sternotomy (MS). Methods:We performed a retrospective analysis of 49 patients who underwent isolated TV surgery as a reoperation at our institution between 2006 and 2015. Previous cardiac operations included mitral, aortic, and TV surgeries, atrial septal defect repair, and pericardiectomy. The mean age of the patients was 51.9±12.8 years, 14 (28%) were male and 35 (72%) were female. Follow-up was 95% (38/40) complete, with a mean duration of 41.3±19.5 months.Results: Perioperative demographic and laboratory tests did not show any significant differences between the RAMT and MS groups. The drainage volume, total red cell unit, total serum volume and platelet were significantly different 1150±803.5/2,270±1,920, 4.8±4.1/8.7±8.9, 478.2±488.9/950.0±857.6, 0.04±0.21/0.38±0.64 (P<0.05), while other perioperative data were similar. There were no significant differences in early postoperative death and complications between the RAMT and MS groups.A multivariate linear regression analysis predicted that serum creatinine (Scr), age, and MS group were independent risk factors for bleeding. The Cox regression demonstrated that the MS group had a longer drainage duration (P<0.05) and had a relative hazardous risk (HR) of 2.691 (1.328, 5.450 CI) compared with the RAMT group. Conclusions:The RAMT approach is an alternative, safe, and feasible procedure for isolated TV reoperation. It has the advantages of less drainage and reduced requirement for blood products.

Minimally invasive tricuspid valve surgery

“…Interestingly, Maimaiti and colleagues reported shorter bypass times in their MITS group (78.4±31.2 min) compared to the median sternotomy (90.9±22.8 min). This can be explained by the fact that all their patients had redo surgery (32). Our results showed total bypass times of 139.8±46.4 minutes.…”

“…They have reported renal failure incidence of 30.8% (52). In their comparative study, Maimaiti and colleagues reported a higher risk of acute kidney injury (AKI) in their sternotomy group reaching 35% compared to 13% in the MITS group (32). They have also reported equal incidence of new renal haemodialysis post-operatively of 13%.…”

“…Surgical techniques for repair and replacement in MITS are the same to those in the standard sternotomy approach (Figure 5). There are many reports of achieving satisfactory results with complex repairs performed with the minimally invasive approach (32).…”

“…This is believed to be caused by the smaller incision and minimal dissection to achieve a satisfactory view of the operative field (44). Maimaiti and colleagues (32) showed less bleeding during the first 24 hours in the MITS with a mean of 420 mL compared to 589.6 mL in the sternotomy group. They also measured the total drainage in both groups and found a mean total of 1,151.7 mL in the MITS group compared to 2,276.2 mL in the sternotomy group.…”

“…Recently, many studies have precluded those finding by reporting equal or less incident of CVA with the utilization of retrograde perfusion (49). In particular to isolated MITS, Maimaiti and colleagues have reported 4% risk of stroke with compared to no stroke reported in the sternotomy cases (32). Faber and colleagues reported no stroke in their primary MITS group.…”