Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach

Mihos, Christos G.; Pineda, Andrés M.; Davila, Hector; Larrauri-Reyes, Maiteder; Santana, Orlando

doi:10.1097/imi.0000000000000191

Cited by 13 publications

(21 citation statements)

References 31 publications

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“…Median sternotomy is the standard approach for redo surgery and in patients where the tricuspid valve must be treated. However, as the development of minimally invasive surgery for atrioventricular valves, atrial septal defects, and atrial fibrillation, this technique has also been used in redo surgeries [8,9]. Some centers have reported their experience with minimally invasive tricuspid valve surgery [10][11][12], but the details of surgical techniques (such as arterial inflow, venous drainage, aortic cross-clamping or not, and cooling temperature) varied among different centers.…”

Section: Introductionmentioning

confidence: 99%

Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery

Song

Yao

et al. 2020

J Cardiothorac Surg

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Background: Redo isolated tricuspid valve surgery is associated with a high morbidity and mortality, and its optimal timing remains controversial. Hence, here we reviewed the early and midterm results of simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery in patients at high risk. Methods: A total of 32 consecutive patients underwent a redo isolated tricuspid valve surgery using minimally invasive, beating-heart technique through a right lateral thoracotomy in our center between June 2016 and April 2020. The mean age of patients was 57.4 ± 8.3 years, and 18 patients (56.3%) were women. The mean preoperative EuroSCORE was 7.8 ± 1.4 (range: 6-11). Follow-up was 87.1% complete, with a mean duration of 26.3 ± 12.3 months. Results: Both in-hospital and 30-day mortalities were 3.1%. Tricuspid valve replacement with bioprosthesis was performed in 30 patients (93.8%), and the remaining two patients (6.2%) underwent tricuspid repair (annuloplasty and leaflet reconstruction). The mean cardiopulmonary bypass time was 81.5 ± 29.0 min. The overall in-hospital duration and intensive care unit (ICU) times were 13.6 ± 7.6 days and 4.1 ± 2.8 days, respectively. Postoperative complications included prolonged ventilation in six patients (18.8%), acute kidney injury in three patients (9.4%), and neurologic event, wound infection, or permanent third-degree atrioventricular block, in one patient (3.1%) each. A total of 96.9% patients were discharged uneventfully. Four patients were lost to follow-up; there were no midterm deaths in patients who were followed up. Conclusions: Simplified, minimally invasive, beating-heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.

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Section: Introductionmentioning

confidence: 99%

Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery

Song

Yao

et al. 2020

J Cardiothorac Surg

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“…The actuarial survival at 5 years was 77.2±2.5%. Finally, Mihos et al evaluated the outcomes of 132 patients who had combined mitral and tricuspid valve surgery via a right thoracotomy, of which 12% underwent re-operative double valve surgery (15). Post-operative outcomes included 6 (5%) cases of acute kidney injury, 6 (5%) re-operations for bleeding, 4 (3%) cerebrovascular accidents, and 5 (4%) in-hospital deaths.…”

Section: Discussionmentioning

confidence: 99%

“…These advantages are seen particularly in high-risk populations, such as elderly and obese patients, and in those who undergoing re-operative valve surgery (6)(7)(8)(9)(10)(11)(12). However, data evaluating the feasibility and benefits of minimally invasive double valve surgery are limited (13)(14)(15). Our study aim was to analyze the outcomes of minimally invasive double valve surgery, performed via a right thoracotomy approach.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of minimally invasive double valve surgery

et al. 2017

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Background: Double valve surgery is associated with an increased peri-operative morbidity and mortality.A less invasive right thoracotomy approach may be a viable alternative to median sternotomy surgery in these higher-risk patients. Methods: We retrospectively analyzed the baseline demographics, operative characteristics, and postoperative outcomes of patients who underwent minimally invasive double valve surgery between January 2009 and December 2011 at our institution. Results: The cohort consisted of 117 patients, of which 68 (58.1%) were female. The mean age was 73±11 years, and the mean left ventricular ejection fraction was 52±11%. There were 43 (36.8%) patients with a history of congestive heart failure, 45 (38.5%) with chronic obstructive pulmonary disease, and 5 (4.3%) had a history of chronic kidney disease. The patients underwent primary (90.6%) or re-operative (9.4%) double valve surgery, which consisted of 50 (42.7%) aortic valve replacement and mitral valve repair, 31 (26.5%) mitral and tricuspid valve repair, 18 (15.4%) aortic and mitral valve replacement, 17 (14.5%) mitral valve replacement with tricuspid valve repair, and 1 (0.9%) aortic valve replacement with tricuspid valve repair.Post-operatively, there were 40 (34.2%) cases of prolonged ventilation, 9 (7.7%) acute kidney injury, 6 (5.1%) re-operations for bleeding, 1 (0.9%) cerebrovascular accident, and 15 (12.8%) cases of atrial fibrillation. The mean total hospital length of stay was 12±12 days, with an in-hospital mortality of 2 (1.7%).Conclusions: A minimally invasive right thoracotomy approach to primary or re-operative double valve surgery is feasible, may be utilized with acceptable peri-operative morbidity and mortality.

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“…In patients undergoing combined mitral and tricuspid valve surgery, Mihos et al, retrospectively evaluated the outcomes of 132 consecutive patients who had a right thoracotomy MIVS (34). The cohort consisted of 88% primary and 12% re-operative double valve surgery, and MVrep was performed in 67%.…”

Section: Double Valve Surgerymentioning

confidence: 99%

Minimally invasive valve surgery in high-risk patients

et al. 2017

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The use of minimally, or less invasive, approaches to cardiac valve surgery has increased over the past decade. Because of its less traumatic nature, early studies in lower risk patients demonstrated the approach to be associated with an enhanced recovery, increased patient satisfaction, and good operative outcomes. With time, despite a steep learning curve, surgeons expanded this approach to perform more complex procedures, and include patients with more co-morbidity. The aim of this publication is to review the current literature involving the use of minimally invasive valve surgery (MIVS) in higher-risk patients.

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Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach

Cited by 13 publications

References 31 publications

Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery

Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery

Outcomes of minimally invasive double valve surgery

Minimally invasive valve surgery in high-risk patients

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