Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis

Färber, Gloria; Tkebuchava, S.; Dawson, Rodolfo Siordia; Kirov, Hristo; Diab, Mahmoud; Doenst, Torsten

doi:10.1055/s-0038-1627452

Cited by 23 publications

(22 citation statements)

References 24 publications

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“…The improvement in the NYHA functional class may be explained in part by the concomitant procedures, but there is increasing evidence that TVR alone improves NYHA functional class. 13 Several studies have shown that FTR should be addressed during an initial left-sided surgery because TR may be progressive and because late surgery for uncorrected FTR has been shown to confer increased risk. 5 Furthermore, concomitant TVR during an initial procedure does not affect operative mortality, 14,15 and it is increasingly supported by published guidelines despite the lack of randomized data proving its benefit.…”

Section: Discussionmentioning

confidence: 99%

Six-Month Performance of a 3-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

Guenzinger

Lange

Rieß³

et al. 2018

Thorac Cardiovasc Surg

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Background Functional tricuspid regurgitation (FTR) secondary to left-sided heart disease may lead to poor quality of life and reduced long-term survival. This study evaluated clinical and functional outcomes of patients undergoing tricuspid valve (TV) repair using a rigid three-dimensional ring (Contour 3D, Medtronic) concomitant with another procedure. Methods From September 2011 to July 2015, 112 patients (mean age 70.9 ± 9.0 years) were enrolled at 10 centers in Europe, Israel, and the United States. Inclusion criteria were FTR ≥ moderate and/or tricuspid annular diameter (TAD) ≥ 40 mm. Echocardiography was planned before surgery and at discharge with echocardiographic and clinical follow-ups performed 6 months postoperatively. Results Three fourths (74.4%) of patients had higher than moderate TR. Mean TAD was 41.0 ± 7.3 mm; 61.7% of patients were in the New York Heart Association (NYHA) class III/IV. The most common concomitant procedure was mitral valve repair (57 patients, 53.3%). The 30-day mortality rate was 0.9% (n = 1). The mean EuroSCORE II was 8.9 ± 8.4% (median: 5.9%; interquartile range: 3.5–11.5%). The observed to expected ratio (O/E) based on the median was 0.1. Six deaths occurred during follow-up (three cardiac related). Mean implanted ring size was 30.3 ± 2.7. At 6 months, 94.4% of patients showed ≤ mild TR, and 92.0% were in NYHA class I/II (p < 0.001 vs baseline for both). Mean pressure gradient across the TV was 2.0 ± 1.1 mm Hg; leaflet coaptation length was 7.5 ± 3.3 mm. Conclusion The Contour 3D annuloplasty ring used for treatment of FTR substantially reduced TR for up to 6 postoperative months with low mean pressure gradients across the TV and significant improvement in NYHA class. Registration www.ClinicalTrials.gov, NCT01532921.

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Section: Discussionmentioning

confidence: 99%

Six-Month Performance of a 3-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

Guenzinger

Lange

Rieß³

et al. 2018

Thorac Cardiovasc Surg

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“…However, due to the freedom from jugular cannulation, our modified inferior caval drainage technique can minimize the anesthetic and preoperative preparing time and decrease the iatrogenic injuries caused by jugular cannulation, for instance, jugular hemotoma, pneumothorax, or hemothorax. 7,12,27 Moreover, a better cosmetic outcome can be acquired thanks to the avoiding of right cervical incision for cannulation, which is notable and may cause keloid and pigmentation. 28 With the evolution of the innovative trans-catheter intervention of TV, TV repair or replacement will be performed by more and more minimally invasive method or maybe even incisionless in the future.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] With the development of minimally invasive cardiac surgery in this decade, a great number of reports have shown better clinical outcomes of the minimally invasive right anterior lateral thoracotomy surgery than traditional median sternotomy surgery for reoperative isolated TV operations. [4][5][6][7] However, the operative visual field through mini-thoracotomy was quite limited until the application totally video-assisted thoracoscopic cardiac surgery, which can bring much better exposure for TV in patients with previous median cardiac surgery than right mini-thoracotomy. As for the intervention of reoperative isolated TR, TV repair can provide better clinical outcomes and less thromboembolic events than TV replacement.…”

Section: Introductionmentioning

confidence: 99%

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Zhou

et al. 2020

Perfusion

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Aim: The aim of this study was to investigate the feasibility, safety, and clinical effect of modified unicaval drainage for thoracoscopic reoperative isolated tricuspid valve repair, compared with conventional bicaval drainage. Methods: A total of 45 consecutive cases of patients who underwent thoracoscopic reoperative isolated tricuspid valve repair on beating-heart were enrolled and divided into two groups according to the different venous drainage (Group A: modified unicaval drainage, Group B: conventional bicaval drainage). A retrospective analysis of perioperative data and clinical outcomes were performed and all the surviving cases were followed up. Re-evaluation of echocardiography and electrocardiogram was performed prior to discharge, and at first month, sixth month, and every year follow-up. Results: The overall postoperative 30-day mortality was 4.5% in Group A and 8.7% in Group B. The postoperative tricuspid valve regurgitation grade of both groups decreased significantly from preoperative regurgitation grade, p < 0.001, without intergroup significant difference, p = 0.815. Follow-up duration ranged from 6 to 38 months, there was one death at 24 months in Group A, and another at 9 months in Group B, respectively. Nobody from both groups experienced reintervention for residual tricuspid regurgitation. No significant difference could be identified about the incidence of postoperative morbidities and follow-up adverse events. Conclusion: Both strategies of caval venous drainage can provide satisfactory exposure for thoracoscopic reoperative isolated tricuspid valve repair and equivalent favorable postoperative outcome. And the modified unicaval drainage group may even preserve the anesthetic time and decrease the risk of iatrogenic jugular injury, achieving a more simplified procedure with better cosmetic outcome.

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“…Despite the common occurrence of PH in patients undergoing TVR/TVr, there is lack of invasive hemodynamic characterization of PH. Prior studies describe PH in patients undergoing TVR/TVr predominantly based on estimated systolic pulmonary artery pressure from echocardiograms (7,8,10). However, echocardiography can significantly underestimate or overestimate pulmonary artery pressures (26).…”

Section: Right Ventricular Function and Pulmonary Hypertensionmentioning

confidence: 99%

“…In addition, the sudden increase in RV preload after TVR/TVr (with the correction of the "pop-off" mechanism) can worsen RV function. However, the threshold of PH that is associated with increased mortality after TVR/TVr is unclear (7)(8)(9)(10). This is because the current literature on the impact of PH on outcomes after TVR/TVr is limited by the lack of invasive hemodynamic measurements.…”

Section: Introductionmentioning

confidence: 99%

Hemodynamic Characteristics and Outcomes of Pulmonary Hypertension in Patients Undergoing Tricuspid Valve Repair or Replacement

et al. 2021

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Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis

Abstract: Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome.

Cited by 23 publications

References 24 publications

Six-Month Performance of a 3-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

Six-Month Performance of a 3-Dimensional Annuloplasty Ring for Repair of Functional Tricuspid Regurgitation

Modified unicaval drainage in reoperative isolated tricuspid valve repair via totally thoracoscopic approach

Hemodynamic Characteristics and Outcomes of Pulmonary Hypertension in Patients Undergoing Tricuspid Valve Repair or Replacement

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