Results
During the study period 68 consecutive patients underwent minimally
invasive tricuspid valve surgery. The mean age was 69+/-14 years and 48
(70%) were female. A redo operation was performed in 5 patients. Table
1 details preoperative patients’ characteristics. Isolated tricuspid
valve repair was performed in 4 patients, while in 64 cases it was
associated with mitral valve surgery +/- AF ablation.
In 17 cases (25%), including the five patients who underwent a redo
operation, an endoaortic balloon clamp was used; in the remaining 51
patients (75%) an external cross clamp was applied. The tricuspid valve
was repaired in all cases with a restrictive annuloplasty using a rigid
ring (Table 2). In combined interventions mean CPB time was 156 +/- 43
(minutes), mean cross clamp time was 118 +/- 32 (minutes). In isolated
TVr mean CPB and cross clamp time were 105 +/- 41 and 74 +/- 6 minutes
respectively. Operative times decreased over the study period: the
analysis of the 2-year interval periods showed that mean CPB time
shortened from 186±48 minutes in the period 2013-2014 to 127±16 minutes
during the period 2019-2020 (anova p=0.002); mean cardioplegic arrest
time decreased from 132±28 minutes in the first two years to 97±13
minutes in the period 2019-2020 (anova p=0.02).
Conversion to sternotomy was necessary in one case for uncontrolled
bleeding from left atrial appendage, damaged by external aortic clamp.
One patient was taken back to theatre for excessive bleeding that was
ultimately controlled through the original right mini-thoracotomy
access. A new perioperative cerebral stroke occurred in one patient; two
patients sustained an episode of transient ischemic attack during the
early postoperative course. The mean stay in ICU was 56 +/- 48 hours and
was prolonged for five patients who suffered low cardiac output syndrome
requiring drug support and, in one case, renal replacement therapy with
CVVHD. Cardiac enzymes were routinely evaluated during the first
postoperative days (table 3), no patient sustained a perioperative
myocardial infarction. In 25 cases (37%) blood transfusion was
performed during the post-operative course. (Table 3. Reports
postoperative laboratory tests).
Three patients developed infection (n=1) and lymphoceles (n=2) with
dehiscence of the inguinal wound; no complications were registered at
the mini-thoracotomy site. All patients were successfully discharged
after a mean hospital stay of 8.9 +/- 7.2 days.
Survival at a 5-year and 8-year follow up was 100% and 79%,
respectively (Figure 1) . (Table 4. Reports early
postoperative outcomes). At follow-up no patient had an NHYA class
greater than two, only one patient was re-hospitalized for heart failure
for an atrial fibrillation episode. One patient was hospitalized for a
pericardiocentesis twenty days after discharge
No severe tricuspid regurgitation was evident at echocardiographic
follow up (Figure 2 ). Five patients had 2+ TR.