Simplified Minimally Invasive Beating Heart Technique for Redo Isolated Tricuspid Valve Surgery

Abstract

BackgroundRedo isolated tricuspid valve surgery has been associated with a high morbidity and mortality, and its optimal timing of surgical intervention remains controversial. Hence, we reviewed our early and midterm results with a simplified minimally invasive beating heart technique for isolated redo tricuspid valve surgery in patients at high risk.MethodsBetween June 2016 and August 2017, a total of 14 consecutive patients underwent isolated tricuspid valve operations after previous cardiac operations with minimally invasive beating heart technique through a right lateral thoracotomy in our center. Mean patient age was 54.0 ± 8.3 years, and 9 patients (64.3%) were women. Mean preoperative EuroSCORE was 8.1 ± 1.3 (6 to 11). Previous cardiac operations included 6 patients (42.9%) with mitral valve replacement, 1 patient (7.1%) with mitral valve replacement and tricuspid valve repair, 1 patient (7.1%) with tricuspid valve replacement, 5 patients (35.7%) with mitral valve and aortic valve replacement, and 1 patient (7.1%) with Ebstein repair. Midterm follow-up was complete for 12 patients (85.7%).ResultsBoth in-hospital and thirty-day mortalities were 0%. Tricuspid valve replacement with bioprosthesis was performed in 12 patients (85.7%), and the remaining 2 patients (14.3%) underwent tricuspid repair (annuloplasty and leaflets reconstruction). Mean cardiopulmonary bypass time was 55.6 ± 10.7 minutes. Overall in-hospital duration and intensive care unit (ICU) time were 11.6 ± 8.8 days, 3.9 ± 2.8 days, respectively. Postoperative complications included 2 patients (1.4%) with prolonged ventilation, and 2 patients (1.4%) with acute kidney injury. There were no postoperative cerebrovascular accidents, myocardial infarctions, reoperations for bleeding, or deep wound infections. All patients were discharged uneventful. Except 2 patients lost follow-up, there were no adverse cardiovascular events and deaths occurred in other patients.ConclusionsSimplified minimally invasive beating heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.