Beating-Heart Totally Endoscopic Tricuspid Valvuloplasty in Reoperative Cardiac Surgery

Abstract

The development of significant TR long after left-sided valve surgery is not uncommon and is closely associated with a poor prognosis. Traditional open-heart tricuspid procedures after previous cardiac surgery is reported with high mortality. Currently, role of Endoscopic Surgery treating late severe tricuspid regurgitation following cardiac surgery remains less investigated. We herein report the technique which is a combination of beating-heart minimally invasive approach and leaflets augmentation technique treating tricuspid regurgitation after cardiac surgery. Outcomes of this technique for severe late tricuspid regurgitation following cardiac surgery are favorable.

Outcomes of redo‐isolated tricuspid valve surgery after left‐sided valve surgery

“…Therefore, we introduced the updated technique of leaflet patch augmentation of both anterior and posterior leaflets by sewing the patch to the leaflets and the annulus to convert the native leaflets into the coaptation zone and (partially) the chordae. 13 Other repair techniques such as ring implantation, artificial chordae, commissurotomy, and papillary muscle incision were also performed as needed. Therefore, the overall CPB time was long because of these combined repair techniques.…”

“…The common issue 19 that tricuspid valve without coaptation and extensive annular dilation was not amenable to repair may persuade a surgeon to replace, but we believe that the augmentation of both anterior and posterior leaflet might address this issue by minimizing the leaflet tethering and increasing the coaptation. Therefore, we introduced the updated technique of leaflet patch augmentation of both anterior and posterior leaflets by sewing the patch to the leaflets and the annulus to convert the native leaflets into the coaptation zone and (partially) the chordae 13 . Other repair techniques such as ring implantation, artificial chordae, commissurotomy, and papillary muscle incision were also performed as needed.…”

“…Some surgical procedures for endoscopic redo‐isolated tricuspid valve repair have been previously described 13 . Four surgeons participated in the study and two were able to perform endoscopic valve surgery; therefore, the selection of endoscopic or median sternotomy approach depended on surgeons’ preference.…”

Outcomes of Redo Isolated Tricuspid Valve Surgery After Left-sided Valve Surgery

“…The common issue [19] that tricuspid valve without coaptation and extensive annular dilation was no amenable to repair may persuade a surgeon to replace, while we believe that the augmentation of both anterior and posterior leaflet might address this issue by minimizing the leaflet tethering and increasing the coaptation. Therefore, we introduced the updated technique of leaflet patch augmentation of both anterior and posterior leaflets by sewing the patch to the leaflets and the annulus to convert the native leaflets into the coaptation zone and (partially) the chordae [13]. Other repair techniques such as ring implantation, artificial chordae, commissurotomy and papillary muscle incision were also performed as needed, and therefore the overall CPB time was long because of these combined repair techniques.…”

“…Right mini-thoracotomy approach, beating-heart surgery, single venous drainage technique and other simplified surgical procedures have been recently applied in redo isolated tricuspid valve surgery (RITS), and outcomes of these evolving surgical strategies were encouraging [8][9][10]. The first totally endoscopic RITS after LSVS at our institution dated back to 2013; surgical techniques were later upgraded in 2015 [11][12][13], and postoperative and early outcomes were encouraging.…”