First Dedicated Minimally Invasive Right Atrial Retractor.

Area of Science:

• Cardiovascular Surgery
• Medical Device Innovation
• Minimally Invasive Cardiac Procedures

Background:

• Correcting tricuspid valve insufficiency is crucial in patients with left-sided valve disease.
• Minimally invasive mitral valve operations are common, but data for isolated tricuspid valve procedures is limited.
• Existing retractors are inadequate for minimally invasive tricuspid valve exposure.

Purpose of the Study:

• To develop and evaluate a dedicated right atrial (RA) retractor for minimally invasive tricuspid valve (TV) operations.
• To address the challenges of TV exposure due to anatomical proximity.
• To create a retractor that is shallow, prevents slippage, and is quick to deploy and remove.

Main Methods:

• A novel fenestrated, shallow, and wide RA retractor with articulating wings was designed.
• A 3D-printed prototype was modified based on feedback from experienced minimally invasive cardiac surgeons.
• The modified retractor was successfully deployed in surgical procedures.

Main Results:

• The RA retractor provided effective, safe, and rapid exposure of the tricuspid valve and surrounding RA structures.
• Full visualization of the tricuspid valve, interatrial septum, vena cava ostia, and coronary sinus was achieved.
• The retractor proved beneficial in various procedures, including isolated TV repairs, myxoma resection, and complex mitral valve operations.

Conclusions:

• The developed minimally invasive RA retractor offers excellent and stable exposure of right atrial structures.
• Fast deployment and removal contribute to the efficiency of minimally invasive cardiac surgery.
• This innovation enhances the feasibility and outcomes of minimally invasive tricuspid valve interventions.