Minimally invasive isolated tricuspid valve surgery

Outcomes after minimally invasive isolated tricuspid valve (TV) surgery have not been well described. Hence, an assessment was made of the authors' results for minimally invasive, isolated TV surgery.

Between September 2000 and January 2008, at the authors' institution, a total of 35 patients (15 males, 20 females; mean age 59.2 +/- 14.9 years) underwent isolated TV surgery for TV regurgitation, using a right lateral mini-thoracotomy. The preoperative left ventricular ejection fraction was 57 +/- 11%. The TV pathology included annular dilatation (n = 22), recurrent regurgitation after previous repair (n = 4), ruptured chordae (n = 4), endocarditis (n = 2), intracardiac tumor (n = 2), and blunt chest trauma (n = 1). Twenty patients had previously undergone a total of 30 cardiac operations, eight of which involved the TV.

A TV repair was performed in 27 patients (77%), and involved the implantation of an annuloplasty ring in all cases. A leaflet repair was performed in addition to an annuloplasty in two patients, and eight patients underwent TV replacement. The hospital mortality was 5.7%, with two deaths due to low cardiac output syndrome on days 1 and 9 after surgery. The latter patient underwent reoperation on day 7 for recurrent TV regurgitation and a ventricular septal defect. Early and mid-term echocardiographic follow up revealed no TV regurgitation in 19 patients, but trivial and mild regurgitation each in eight patients. The mean follow up time was 35 +/- 40 months, and was 100% complete. A Kaplan-Meier analysis revealed an estimated five-year survival of 90% (95% CI: 73-97).

Isolated TV surgery can be performed through a minimally invasive approach, with good results. A high repair rate can be achieved, and the procedure has been particularly valuable in redo surgery.