Minimal access tricuspid valve surgery

Lamelas, Joseph

doi:10.21037/asvide.2017.345

Cited by 4 publications

(5 citation statements)

References 7 publications

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“…8 The same was reported recently by the Miami group, with their results focused on the quicker postoperative recovery and feasibility in cases of redo surgery. 27 We are aware that this study has its limitations. First, it is a retrospective single center study which would have a selection bias in both patients and technique used.…”

Section: Discussionmentioning

confidence: 96%

Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option

Abdelbar

Niranjan

Tynnson

et al. 2020

Innovations�(Phila)

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Objective Isolated tricuspid surgery through median sternotomy can be associated with a high morbidity and mortality. Reports of minimally invasive isolated tricuspid valve operations are rare, but the outcomes are encouraging. We present our experience of endoscopic isolated tricuspid valve surgery. Methods In our institution, 452 patients underwent endoscopic minimal access cardiac surgery between August 2008 and December 2018. A total of 90 patients underwent tricuspid valve surgery whether isolated or with other cardiac procedure. We further selected patients who had isolated tricuspid valve surgery ( n = 24). Of these patients, 13 (54%) had more than one previous sternotomy. Results Tricuspid repair was performed in 18 patients (75%) with the remaining 6 (25%) having bioprosthetic tricuspid replacement. Three (12.5%) were performed with a beating heart, the remaining with endoaortic clamping and cardioplegia. There were no conversions to sternotomy. None of the patients had reoperation for bleeding, tamponade, or valve issues. Three patients (12.5%) required blood transfusion, 3 patients (12.5%) required renal dialysis, and 7 patients (29%) had respiratory complications such as chest infection, requiring continuous positive airway pressure (CPAP) with 2 being re-intubated. One patient (4.1%) died within 30 days from chest sepsis leading to multi-organ failure. Mean hospital stay was 11.1 ± 8.9 days (median of 8). All patients had mild or less regurgitation on follow-up echo at 6 months. Conclusions Isolated tricuspid valve surgery can be performed through an endoscopic minimally access approach, with good results. It appears to provide better results than a sternotomy approach. A high repair rate can be achieved, and the procedure is particularly valuable in redo-surgery with low mortality and morbidity compared to historical sternotomy case series.

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Section: Discussionmentioning

confidence: 96%

Endoscopic Tricuspid Valve Surgery is a Safe and Effective Option

Abdelbar

Niranjan

Tynnson

et al. 2020

Innovations�(Phila)

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“…19 In addition, the minimally invasive right thoracotomy, pioneered in part by this article’s senior author, has been associated with a quicker return to functional activity as well as reduced pain, surgical trauma, and hospital LOS. 20,21…”

Section: Discussionmentioning

confidence: 99%

“…19 In addition, the minimally invasive right thoracotomy, pioneered in part by this article's senior author, has been associated with a quicker return to functional activity as well as reduced pain, surgical trauma, and hospital LOS. 20,21 With these exciting surgical innovations on the horizon, it is imperative for cardiothoracic surgeons to work collaboratively with physician colleagues across disciplines to develop a process to identify and risk stratify patients appropriately, allowing us to effectively provide all patients with TR the treatment options they deserve.…”

Section: Discussionmentioning

confidence: 99%

Isolated Tricuspid Valve Repair Versus Replacement: Predictors of Mortality on the National Level

Alnajar

Arora

Benck

et al. 2023

Innovations�(Phila)

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Objective: Isolated tricuspid valve surgery (TVR) is rarely performed, and literature reports are confined to small sample sizes and old studies. Thus, the advantage of repair over replacement could not be determined. We aimed to evaluate repair and replacement outcomes along with predictors of mortality for TVR on a national level. Methods: All adult patients (18+ years old) who underwent TVR from 2011 to 2020 were identified using the National Inpatient Sample dataset. The primary outcome was in-hospital mortality. Secondary outcomes included complications, length of stay (LOS), hospitalization cost, and discharge disposition. Results: Over a 10-year period, 37,931 patients had TVR and predominantly underwent repair ( n = 25,027, 66.0%). In comparison with patients who underwent tricuspid replacement, more patients with a history of liver disease and pulmonary hypertension presented for repair surgery, and fewer patients had endocarditis and rheumatic valve disease ( P < 0.001). The repair group had less mortality, less stroke, shorter LOS, and reduced cost, while the replacement group had fewer myocardial infarctions ( P < 0.05). However, the outcomes were not different for cardiac arrest, wound complications, or bleeding. After excluding congenital TV disease and adjusting for relevant factors, TV repair was associated with a reduced in-hospital mortality by 28% (adjusted odds ratio [aOR] = 0.72, P = 0.011). Older age increased mortality risk by 3-fold, prior stroke by 2-fold, and liver diseases by 5-fold ( P < 0.001). Patients undergoing TVR in recent years had a better chance of survival (aOR = 0.92, P < 0.001). Conclusions: TV repair has better outcomes than replacement does. Patient comorbidities and late presentation play an independently significant role in determining outcomes.

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“…In general, occlusion of both the superior and inferior venae cavae is needed to prevent air entry into the venous system while operating on right heart structures; however, successful operation without IVC occlusion has also been reported. 3 The Fogarty balloon catheters are available in different lengths, balloon sizes, and shapes; therefore, surgeons can select the one that is suitable for their patients. Echocardiography or computed tomography can measure caval diameters to help select the appropriate balloon size.…”

Section: Discussionmentioning

confidence: 99%