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Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Bettina Pfannmueller1, Martin Misfeld1, Piroze Davierwala1

  • 1Department of Heart Surgery, Leipzig Heart Centre, Leipzig University Hospital, Leipzig, Germany.

The Thoracic and Cardiovascular Surgeon
|January 1, 2020
PubMed
Abstract

Insights

Minimally invasive mitral valve repair with concomitant tricuspid valve surgery is safe, showing no increased early mortality. Prolonged bypass times during these combined procedures do not significantly impact patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Minimally Invasive Cardiac Surgery

Background:

  • Concomitant tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debated due to concerns about prolonged surgical times and increased operative risk.
  • This study investigates cardiopulmonary bypass times and 30-day mortality in patients undergoing MV repair with and without concurrent TV surgery.

Purpose of the Study:

  • To evaluate the safety and early mortality associated with minimally invasive mitral valve repair combined with tricuspid valve surgery.
  • To determine if extended cardiopulmonary bypass times in these combined procedures correlate with increased operative risk.

Main Methods:

  • Retrospective evaluation of 3,962 patients with mitral valve regurgitation undergoing minimally invasive MV repair.
  • Comparison between patients without (MVr group, n=3,463) and with (MVr+TVr group, n=499) concomitant TV surgery between 1999 and 2014.
  • Propensity score matching was employed to account for significant differences in preoperative parameters between the groups.

Main Results:

  • Mean cardiopulmonary bypass time was longer for the MVr+TVr group (162.0 min) compared to the MVr group (125.5 min) (p < 0.001).
  • Initial 30-day mortality was higher in the MVr group (4.8%) versus the MVr+TVr group (2.1%) (p < 0.001).
  • After propensity score matching, no significant difference in 30-day mortality was observed (3.3% vs. 1.2%; p = 0.07), and bypass time was not a significant predictor of early mortality in the MVr+TVr cohort.

Conclusions:

  • Minimally invasive tricuspid valve repair using prosthetic rings is a safe procedure, not associated with elevated early mortality.
  • Prolonged cardiopulmonary bypass time alone should not preclude combined MV repair and TV repair.
  • Prosthetic ring implantation for TV repair is a viable alternative to suture techniques, offering comparable safety outcomes.

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