Thoracoscopic and robotic tricuspid valve annuloplasty with a biodegradable ring: an initial experience

Ring annuloplasty is a technically demanding and time-consuming thoracoscopic and/or robotic surgery. The initial experience of the authors with the intra-annular Bioring tricuspid ring using a minimally invasive access is reviewed, and some modifications are proposed to adapt to the particularities of these approaches.

Patients undergoing minimally invasive tricuspid annuloplasty were included prospectively between March and September 2008. The feasibility and ease of implantation were evaluated. A total of 10 patients (six females, four males) was included (eight with functional regurgitation, two with endocarditis). Six patients underwent surgery through a small anterolateral thoracotomy, and the da Vinci S robotic system was used in four cases.

The mean cardiopulmonary bypass and aortic cross-clamp times were 123 +/- 30 min and 86 +/- 28 min, respectively. Ring implantation was successful in all patients. There was one late death from multiple organ failure. None of the patients required reoperation. At discharge from hospital, seven patients had no or discrete tricuspid regurgitation (TR), and two had moderate TR with no tricuspid stenosis but remained stable during the follow up period.

The biodegradable Bioring offers a simple and quick implantation which is feasible and simplified in minimally invasive approaches.