Isolated Reoperative Minimally Invasive Tricuspid Valve Operations

Background. Tricuspid valve (TV) regurgitation has recently been identified as a major risk factor for long-term mortality. Isolated reoperative tricuspid valve repair/replacement (TVR/r) carries an excessively high operative risk. Currently, isolated TVR/r with minimally invasive access through a right lateral thoracotomy is being used increasingly in our institution to treat progressive TV pathologic processes after previous cardiac operations. We analyzed our early and midterm results with reoperative TVR/r in this unique patient cohort. Methods. Forty-eight consecutive patients underwent isolated TV operations after previous cardiac operations with minimally invasive access through a right lateral thoracotomy at our institution between September 2000 and December 2011. Previous cardiac operations included 26 patients (54.2%) with mitral valve replacement/repair, 18 patients (37.5%) with an aortic valve replacement, 10 patients (20.4%) with a TVR/r, and 8 patients (16.7%) with coronary artery bypass grafting. Operations were performed electively in 79% of patients (n = 38). Mean patient age was 63.8 +/- 13.4 years, with an average log EuroSCORE of 13.9% +/- 11.3%; 67% of patients were women. Follow-up was 94% complete, with a mean duration of 2.8 +/- 2.3 years. Results. Thirty-day mortality for patients undergoing elective surgery was zero. For all patients early mortality was 4.2%. Five-year survival for patients after elective reoperative TVR/r through minimally invasive access was 72.2% +/- 10.0%, and 5-year freedom from TV-related reoperations was 88.1% +/- 6.7%, respectively. Conclusions. Minimally invasive access through a right thoracotomy provides a safe option for reoperative TVR and offers excellent early outcome, particularly in elective cases. Surgical intervention should be performed earlier rather than later. (Ann Thorac Surg 2012;94:2005-10) (c) 2012 by The Society of Thoracic Surgeons