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Updated: Jun 18, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Results of 141 consecutive minimally invasive tricuspid valve operations: an 11-year experience
Teng C Lee1, Bhargavi Desai, Donald D Glower
1Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina 27705, USA.
Background:
Reports of minimally invasive tricuspid valve operations are rare. We reviewed our experience and results of tricuspid valve operation using mini-thoracotomy during an 11-year period.
Methods:
Consecutive patients (n = 141) undergoing tricuspid valve operation using mini-thoracotomy were retrospectively analyzed. Access was through a 6-cm right thoracotomy and cardiopulmonary bypass was instituted by means of the femoral artery (n = 16) or ascending aorta (n = 125) with augmented venous return. In most cases, vacuum assist without caval occlusion and snaring the cavae was used to minimize mediastinal dissection. In all cases, the tricuspid valve operation was done with the heart unclamped, and the heart either beating or fibrillating.
Results:
Seventy-three percent (103 of 141 patients) of the patients underwent combined mitral and tricuspid valve operations. The tricuspid valve was repaired instead of being replaced in 61% (86 of 141 patients). Previous sternotomy was present in 49% (69 of 141 patients). The average patient age was 64 years. Conversion rate to median sternotomy was only 3% (4 of 141 patients). The mean cardiopulmonary bypass time was 216 minutes. Thirty-day mortality was 2.1% (3 of 141 patients). Stroke occurred in 2.8% (4 of 141 patients), and reexploration for bleeding occurred in 5.6% (8 of 141 patients). The stroke rate was 3 of 16 patients (18.8%) using mini-thoracotomy through femoral cannulation versus 1 of 125 patients (0.8%) through aortic cannulation (p = 0.005).
Conclusions:
In this largest reported series of patients undergoing tricuspid valve operation, mini-thoracotomy provides excellent short-term morbidity and mortality in these high-risk patients while avoiding redo sternotomy with a low conversion rate. Mini-thoracotomy with aortic cannulation is an attractive alternative approach to the tricuspid valve, particularly in patients with previous sternotomy.
Insights
Minimally invasive tricuspid valve surgery using mini-thoracotomy offers excellent outcomes for high-risk patients. This approach, especially with aortic cannulation, is a safe alternative, particularly for those with prior sternotomy.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Minimally invasive tricuspid valve operations are infrequently reported.
- This study reviews an 11-year experience with mini-thoracotomy for tricuspid valve procedures.
Purpose of the Study:
- To evaluate the safety and efficacy of mini-thoracotomy for tricuspid valve operations.
- To assess short-term morbidity and mortality in a high-risk patient cohort.
Main Methods:
- Retrospective analysis of 141 patients undergoing tricuspid valve operation via mini-thoracotomy.
- Access through right thoracotomy; cardiopulmonary bypass via femoral or ascending aorta cannulation.
- Tricuspid valve procedures performed on an unclamped, beating or fibrillating heart, often using vacuum assist without caval occlusion.
Main Results:
- 61% of tricuspid valves were repaired; 73% underwent combined mitral and tricuspid procedures.
- Low conversion rate to median sternotomy (3%); 30-day mortality was 2.1%.
- Stroke rate was significantly higher with femoral cannulation (18.8%) versus aortic cannulation (0.8%).
Conclusions:
- Mini-thoracotomy provides excellent short-term outcomes for high-risk tricuspid valve surgery.
- Avoids redo sternotomy and has a low conversion rate.
- Mini-thoracotomy with aortic cannulation is a favorable approach, especially for patients with previous sternotomy.
