Minimally invasive tricuspid valve surgery in patients at high risk

Objective: Reports of minimally invasive tricuspid valve operations are rare, and results are often contradictory. This study analyzes our 5-year experience with minimally invasive tricuspid valve operations in high-risk patients. Methods: Between November 2005 and December 2011, tricuspid valve surgery using a nonsternotomy minimally invasive technique was performed in 64 patients (19 male, 45 female; mean age, 63.2 +/- 12.8 years). Mean preoperative European System for Cardiac Operative Risk Evaluation was 7.3 +/- 2.9, and predicted mortality was 11.6% +/- 11.7%. Tricuspid valve regurgitation cause was functional in 36 patients (56.2%), endocarditis in 2 patients (3.1%), and rheumatic in 24 patients (37.5%). Two patients (3.1%) showed prosthesis dysfunction. Forty patients (62.5%) had undergone previous cardiac surgery. Results: Tricuspid valve repair was performed in 35 patients (54.7%). Tricuspid valve replacement with bioprosthesis was performed in 27 patients (42.2%), and the remaining 2 patients (3.1%) underwent bioprosthetic replacement. Concomitant procedures (48) included mitral valve surgery (42 patients), atrial septal defect closure (5 patients), and myxoma exeresis (1 patient). Conversion to sternotomy occurred in 1 patient (1.6%). Overall hospital mortality was 7.9%. Stroke occurred in 1 patient (1.6%), and 5 patients underwent reoperation for bleeding (7.8%). Mean follow-up time was 21 +/- 16 months (range, 1-59 months) and 100% completed. Cumulative Kaplan-Meier estimated 5-year survival was 81.3%, and 5-year freedom from reoperation was 100%. Conclusions: The heart-port-based minimally invasive approach seems to be safe, feasible, and reproducible in case of tricuspid valve operations. It ensures low perioperative morbidity, moderate to low rates of tricuspid regurgitation recurrence, and low late mortality. It also seems to have an added value in case of reoperative procedures.