Minimally invasive tricuspid valve surgery

Abstract

Tricuspid valve disease carries a very unfavorable prognosis when medically treated. Despite that, surgical intervention is still underperformed for tricuspid valve disease due to the reported high morbidity and mortality from a sternotomy approach. This had led to a shift towards maximizing medical therapy for right ventricular failure and, as a result, a more significant delay in surgical referrals with surgical risks when patients are finally referred. Tricuspid valve patients usually have other co-morbidities resulting from their systemic venous congestion and low flow cardiac output. Minimally invasive tricuspid valve surgery provides less tissue injury and, as a result, less trauma during surgery. This provides a hope for both patients and treating doctors to be more open for providing this procedure with less complications. Isolated minimally invasive tricuspid valve surgery is still not performed as widely as expected. This can be partly due to the adverse outcomes historically labelled to tricuspid valve surgery or by the long journey of learning the surgical team would need to commit to with a minimal access approach. In this article we will review the perioperative pathway, and outcomes of isolated minimally invasive tricuspid valve surgery in the available English literature.

Funkcinis Triburio Vožtuvo Nesandarumas

“…Triburio vožtuvo nesandarumas (TVN) yra sąlyginai dažna, progresuojanti ir sunki liga, susijusi su prasta gyvenimo kokybe bei padidėjusiu mirštamumu [2]. Esant nepažeistai triburio vožtuvo anatomijai, mažo laipsnio TVN laikomas nepatologiniu.…”

“…Gabrielė Jakuškaitė 1 , Giedrė Vanagaitė 1 , Aušra Krivickienė 2 , Eglė Ereminienė 2 1 Lietuvos sveikatos mokslų universiteto Medicinos akademija, 2 Lietuvos sveikatos mokslų universiteto Kauno klinikų Kardiologijos klinika 131 triburio vožtuvo nesandarumo diagnostiką bei taikomus gydymo metodus. Pasirinktos anglų kalba skelbtos publikacijos.…”

Minimal Access Tricuspid Valve Surgery

“…Additionally, patients presenting late with advanced degrees of RV dilation/dysfunction and/or fixed pulmonary hypertension are unlikely to benefit from the surgery [ 8 ]. Minimal access tricuspid valve surgery (MATVS; direct vision, endoscopic and robotic) mitigates some of this risk which could allow for earlier and more appropriate timing of the intervention to promote reverse RV remodeling, avoid organ failure, and improve functional status [ 9 , 10 ].…”

Commentary: A new gadget for redo tricuspid surgery

“…In the setting of redo isolated tricuspid valve (TV) surgery, a right thoracotomy approach is a reasonable alternative to redo sternotomy, by which time consumption required to dissect into the pericardial space can be reduced while injury to the heart and great vessels during the adhesiolysis can also be minimized. 1 , 2 As isolated TV surgery can also be performed under beating heart without a need of aorta manipulation, the so-called “minimalist approach” of performing TV surgery under beating heart using a minithoractomy and percutaneous peripheral cannulations has been popularized by leading experts in recent years. 2 For a more reproducible execution of this procedure, it is important to secure effective venous drainage so that venous blood does not interfere with exposing TV.…”

“… 1 , 2 As isolated TV surgery can also be performed under beating heart without a need of aorta manipulation, the so-called “minimalist approach” of performing TV surgery under beating heart using a minithoractomy and percutaneous peripheral cannulations has been popularized by leading experts in recent years. 2 For a more reproducible execution of this procedure, it is important to secure effective venous drainage so that venous blood does not interfere with exposing TV. In addition, venous drainage should not be interrupted by air trapping in the draining cannulae.…”