Minimally-invasive tricuspid valve operations: three decades of Leipzig experience

Data on minimally invasive tricuspid valve surgery for severe tricuspid regurgitation remain limited, particularly regarding long-term outcomes.

This retrospective single-center study included adult patients who underwent minimally invasive tricuspid valve surgery through right mini-thoracotomy for severe tricuspid regurgitation as the primary indication between 1996 and 2024. Patients with endocarditis or tricuspid stenosis, as well as those undergoing left-sided valve surgery, were excluded. The primary endpoint was all-cause mortality during follow-up.

A total of 199 patients with a median age of 70.0 years, including 110 (55%) women, were analyzed. Sixty-four (32%) had previous cardiac surgery. Median EuroSCORE II was 3.6% (1.8-6.0) and median TRI-SCORE-predicted mortality was 5.0% (3.0-14.0). Three patients (1.5%) required conversion to sternotomy. Tricuspid valve repair was performed in 108 patients (54%). In-hospital mortality was 6% for the entire cohort (12/199). Discharge echocardiography demonstrated no or mild residual tricuspid regurgitation in 176/194 patients (91%). Estimated overall survival was 85% (95% confidence interval, 80-90%) at 1 year, 69% (62-75%) at 5 years, and 53% (46-61%) at 10 years. Repeat tricuspid valve surgery was recorded in 7 patients (4%). In multivariable analysis, older age, male sex, urgent/emergent operation, atrial fibrillation/flutter, diabetes mellitus, signs of right heart failure, lower glomerular filtration rate and lower preoperative hemoglobin independently predicted mortality.

Minimally invasive tricuspid valve surgery for severe tricuspid regurgitation was associated with low conversion rates and provided good early and late outcomes. Repair was performed in over half of patients.