Introduction
Tricuspid regurgitation (TR) has become a substantial problem because of its high prevalence and poor clinical outcomes. A conservative estimate of total burden of moderate or severe TR in the US is 2.4 million residents both diagnosed and undiagnosed [1]. A large-scale investigation study in China indicated that the rates of moderate and severe TR was 2.22% and 1.39%, respectively [2]. Long-term, higher-grade TR was an independent risk factor and associated with worse survival [3-5].
Clinical guidelines have adopted broader indications: surgery for mild-to-moderate TR with tricuspid annulus dilatation or right-heart failure undergoing left-sided valve surgery and primary symptomatic severe TR [6, 7]. Nevertheless, surgical correction and its optimal timing for isolated TR after left-sided valve surgery (LSVS) remains unclear.
Right mini-thoracotomy approach, beating-heart surgery, single venous drainage technique and other simplified surgical procedures have been recently applied in redo isolated tricuspid valve surgery (RITS), and outcomes of these evolving surgical strategies were encouraging [8-10]. The first totally endoscopic RITS after LSVS at our institution dated back to 2013; surgical techniques were later upgraded in 2015 [11-13], and postoperative and early outcomes were encouraging.
The present study aimed to review evolving strategies for RITS after LSVS at our institute in recent years, summarizing mid-to-long term outcomes and comparing the totally endoscopic approach with traditional median sternotomy approach.