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DOI: 10.1055/s-0034-1367404
Simplified minimally-invasive technique for safe isolated tricuspid re-do surgery
Objectives: Isolated tricuspid valve surgery is still considered a high risk procedure with perioperative mortality rates of up to 30%. Recent reports describe minimally invasive approaches with improved outcomes. However, total cardiopulmonary bypass (CPB) with occlusion of the caval veins is still standard for accessing the tricuspid valve, a requirement that may be technically challenging in redo cases. We report a minimally-invasive technique and its outcomes for isolated tricuspid valve redo-surgery on partial CPB with the heart beating.
Methods: From April 2011 to June 2013, 8 patients with severe isolated tricuspid regurgitation and previous cardiac surgery for various reasons underwent tricuspid repair (n = 7) or replacement (n = 1). CPB was established percutaneously through groin cannulation. The only thoracic incision was a 5 cm anterolateral minithoracotomy. The pericardium covering the right atrium was exposed. The principle of the procedure is a relatively anterior atriotomy and the creation of a “right atrial reservoir” allowing exposure of the tricuspid valve and adequate venous drainage despite the lack of caval occlusion. Specifically, the pericardium is incised together with the wall of the right atrium. Exposition sutures are placed on the upper rim of the incision and the table is slightly tilted to the right.
Results: The procedures were performed successfully in all 8 patients. Postoperatively, there was no bleeding that required revision. There was no evidence for hemolysis. There was no new stroke. One patient with recurrent preoperative strokes suffered from temporary delirium. One patient required re-intubation for pneumonia. Importantly, there was no adverse event that could be related to the use of partial CPB and there was no mortality.
Conclusion: Performing tricuspid valve surgery as reoperation without caval occlusion and on the beating heart significantly facilitates surgical access to the tricuspid valve. The procedure is safe and allows performing both repair and replacement.