Outcomes of Totally Endoscopic Beating-Heart Tricuspid Repair in Redo Cardiac Surgery.

BACKGROUND

The role of endoscopic surgery in treating late severe tricuspid regurgitation after cardiac surgery has not been well investigated. The aim of this study was to evaluate the outcomes of a combination of a beating-heart, minimally invasive approach and a leaflet-augmentation technique in treating tricuspid regurgitation after cardiac surgery.

METHOD

This was a retrospective cohort study. From January 2015 to July 2018, patients undergoing reoperative tricuspid valve repair with a totally endoscopic approach were enrolled. Procedures were performed on beating hearts with normothermic cardiopulmonary bypass (CPB).

RESULTS

A total of 43 adults (mean age 53.4±11.4 yr; 9 men) met the inclusion criteria. The interval between prior cardiac surgery and current tricuspid repair was 17.6±6.5 years. Ten (10) patients had previous tricuspid repair and concomitant previous cardiac surgery. In the current endoscopic approach, tricuspid repair techniques included 38 leaflet augmentations, 38 annular ring placements, five artificial chordae, one cleft closure, five commissure recreations, and eight papillary muscle relaxations. Mean CPB time, median ventilation time, and median hospital stay were 128.5±54.2 minutes, 20.5 hours (range, 6-436 hrs), and 7 days (range, 4-56 d), respectively. There were only three in-hospital deaths and no follow-up mortality. The regurgitant jet area was decreased from 21.5±12.1 cm preoperatively to 2.4±2.2 cm postoperatively (p<0.001). In patients with previous tricuspid repair, although the technique of valvuloplasty seems more complex, CPB time, procedure time and hospital stay were not longer than in patients who did not have previous tricuspid repair.

CONCLUSIONS

Beating-heart, video-assisted, minimal access tricuspid repair after previous cardiac surgery is feasible, reproducible, and associated with low mortality, even in patients who have had previous tricuspid repair.