Comparison of Minithoracotomy versus Sternotomy in 304 Consecutive Tricuspid Valve Operations

: The relative outcomes of sternotomy versus thoracotomy for tricuspid valve operation were examined over a 22-year period.

: Three hundred four consecutive patients undergoing tricuspid valve operation using right minithoracotomy (THORC group; n = 124) versus median sternotomy (STERN group; n = 180) between 1985 and 2007 were retrospectively analyzed. Minithoracotomy used a 6-cm incision with femoral venous cannulation and augmented venous return. Sternotomy patients undergoing aortic valve, coronary bypass, or other procedure not feasible through a right minithoracotomy were excluded.

: Both groups were similar except that STERN patients had an earlier operative year. Combined mitral and tricuspid valve operation was performed in 70% (214/304) of patients. The tricuspid valve was repaired in 59% (180/304) of patients. Previous sternotomy was present in 56% (171/304) of patients. The mean cardiopulmonary bypass times were longer in the THORC group (216 vs. 167 minutes, P < 0.0001). THORC was associated with a lower 30-day mortality (2% vs. 11%, P = 0.007), less atrial fibrillation (18% vs. 34%, P = 0.0025), less renal failure (3% vs. 11%, P = 0.016), and shorter length of stay (11 vs. 15 days, P = 0.012), although these differences were less apparent in more recent years. Stroke (3% vs. 2%, P = 0.72), respiratory failure (7% vs. 31%, P = 0.06), and infection rates (11% vs. 16%, P = 0.25) were similar. Five-year survival was also similar (63% vs. 64%, P = 0.84).

: Given the limitations of a large, retrospective experience, minithoracotomy versus sternotomy is associated with low short-term morbidity and mortality, with advantages of avoiding sternotomy and minimizing mediastinal dissection in an otherwise high-risk group of patients.