Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations

Outcomes for a port-access (PA) approach for tricuspid valve operations have not been reported or compared to those using median sternotomy (MS).

Retrospective analysis was performed for 88 consecutive patients undergoing tricuspid valve repair or replacement using port-access techniques (n = 27, 1997-2000) versus sternotomy (n = 61, 1990-1997). PA procedures were performed through a 6 cm right fourth interspace thoracotomy.

PA patients had lower ejection fractions (46% +/- 11% vs. 54% +/- 10%, p = 0.02), but had a similar incidence of previous surgery (17/27 (63%) vs. 33/61 (54%), p = 0.4). PA patients had more frequent concurrent mitral valve operations (22/27 (82%) vs. 37/61 (61%), p <0.05) and more tricuspid repairs versus replacement (24/27 (89%) vs. 29/61 (48%), p <0.01). PA patients had longer pump times (254 min. +/- 82 vs. 162 min. +/- 61, p = 0.001) but comparable clamp times (65 min. +/- 15 vs. 63 min. +/- 41, p = 0.9), lengths of stay (14 days +/- 14 vs. 16 days +/- 16, p = 0.6), mortality (2/27 (7%) vs. 9/61 (15%), p = 0.3), strokes (3/27 (11%) vs. 4/59 (7%), p = 0.9), and need for new pacemaker implantation (5/27 (19%) vs. 12/61 (20%), p = 0.9).

PA provided excellent short-term results comparable to MS in relatively high-risk tricuspid valve patients. For tricuspid operations, PA may have the advantage of avoiding sternotomy or reoperative sternotomy at the expense of longer pump times.