Thorac Cardiovasc Surg 2018; 66(07): 564-571
DOI: 10.1055/s-0038-1627452
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis

Gloria Färber
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Sophie Tkebuchava
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Rodolfo Siordia Dawson
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Hristo Kirov
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Mahmoud Diab
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
,
Peter Schlattmann
2   Institute of Medical Statistics, Computer Sciences and Documentation, University Hospital Jena, Jena, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, University Hospital Jena, Jena, Germany
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

10. Oktober 2017

03. Januar 2018

Publikationsdatum:
19. April 2018 (online)

Abstract

Background Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy.

Methods We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n = 26) and compared them to redo-Sternotomy (n = 17). A group of primary-MITS (n = 61) served as control.

Results The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II: 9.83 ± 6.05% versus redo-Sternotomy: 8.42 ± 7.33% versus primary-MITS: 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo-MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR] = 9.76; 95% confidence interval [CI] 1.88–63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20–54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02–1.35) as independent predictors of 30-day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR] = 2.67; 95% CI 1.18–6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45–7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04–4.92) as risk factors for poor long-term survival. TV surgery significantly reduces NYHA class.

Conclusion Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome.

 
  • References

  • 1 Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004; 43 (03) 405-409
  • 2 Nishimura RA, Otto CM, Bonow RO. , et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014; 63 (22) e57-e185
  • 3 Vahanian A, Alfieri O, Andreotti F. , et al; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012; 42 (04) S1-S44
  • 4 Kim YJ, Kwon DA, Kim HK. , et al. Determinants of surgical outcome in patients with isolated tricuspid regurgitation. Circulation 2009; 120 (17) 1672-1678
  • 5 Chen SW, Tsai FC, Tsai FC. , et al. Surgical risk and outcome of repair versus replacement for late tricuspid regurgitation in redo operation. Ann Thorac Surg 2012; 93 (03) 770-775
  • 6 Campelo-Parada F, Perlman G, Philippon F. , et al. First-in-man experience of a novel transcatheter repair system for treating severe tricuspid regurgitation. J Am Coll Cardiol 2015; 66 (22) 2475-2483
  • 7 Latib A, Agricola E, Pozzoli A. , et al. First-in-man implantation of a tricuspid annular remodeling device for functional tricuspid regurgitation. JACC Cardiovasc Interv 2015; 8 (13) e211-e214
  • 8 Lauten A, Doenst T, Hamadanchi A, Franz M, Figulla HR. Percutaneous bicaval valve implantation for transcatheter treatment of tricuspid regurgitation: clinical observations and 12-month follow-up. Circ Cardiovasc Interv 2014; 7 (02) 268-272
  • 9 Schofer J, Bijuklic K, Tiburtius C, Hansen L, Groothuis A, Hahn RT. First-in-human transcatheter tricuspid valve repair in a patient with severely regurgitant tricuspid valve. J Am Coll Cardiol 2015; 65 (12) 1190-1195
  • 10 Pfannmüller B, Misfeld M, Borger MA. , et al. Isolated reoperative minimally invasive tricuspid valve operations. Ann Thorac Surg 2012; 94 (06) 2005-2010
  • 11 Jiang Z, Mei J, Ding F. , et al. Application of endovascular occlusion of both caval veins in minimally invasive isolated redo tricuspid surgery through right thoracotomy. Heart Lung Circ 2014; 23 (02) 186-189
  • 12 Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med 2002; 21 (16) 2409-2419
  • 13 Royston P, Sauerbrei W. Multivariable Model Building: A pragmatic Approach To Regression Analysis Based On Fractional Polynomials For Modelling Continuous Variables. Chichester: John Wiley & Sons; 2008
  • 14 De Bonis M, Taramasso M, Lapenna E, Alfieri O. Management of tricuspid regurgitation. F1000Prime Rep 2014; 6: 58
  • 15 Raja SG, Dreyfus GD. Surgery for functional tricuspid regurgitation: current techniques, outcomes and emerging concepts. Expert Rev Cardiovasc Ther 2009; 7 (01) 73-84
  • 16 El-Eshmawi A, Tang GH, Verma S, Yanagawa B, Ruel M, Adams DH. Innovations in tricuspid valve intervention. Curr Opin Cardiol 2017; 32 (02) 166-173
  • 17 Ricci D, Boffini M, Barbero C, El Qarra S, Marchetto G, Rinaldi M. Minimally invasive tricuspid valve surgery in patients at high risk. J Thorac Cardiovasc Surg 2014; 147 (03) 996-1001
  • 18 Casselman FP, La Meir M, Jeanmart H. , et al. Endoscopic mitral and tricuspid valve surgery after previous cardiac surgery. Circulation 2007; 116 (11, Suppl): I270-I275
  • 19 Minol JP, Boeken U, Weinreich T. , et al. Isolated tricuspid valve surgery: a single institutional experience with the technique of minimally invasive surgery via right minithoracotomy. Thorac Cardiovasc Surg 2017; 65 (08) 606-611
  • 20 Urbandt P, Santana O, Mihos CG, Pineda AM. , Joseph Lamelas Minimally invasive approach for isolated tricuspid valve surgery. J Heart Valve Dis 2014; 23 (06) 783-787
  • 21 Hanedan MO, Çiçekçioğlu F, Aksöyek A. , et al. Tricuspid valve replacement through right thoracotomy has better outcomes in redo cases. Heart Lung Circ 2017; 26 (01) 88-93
  • 22 Sansone F, Barbero C, Rinaldi M. Occlusion of both caval veins by an endovascular occluder. Heart Lung Circ 2012; 21 (05) 275-277
  • 23 Bernal JM, Morales D, Revuelta C, Llorca J, Gutiérrez-Morlote J, Revuelta JM. Reoperations after tricuspid valve repair. J Thorac Cardiovasc Surg 2005; 130 (02) 498-503
  • 24 Pfannmüller B, Moz M, Misfeld M. , et al. Isolated tricuspid valve surgery in patients with previous cardiac surgery. J Thorac Cardiovasc Surg 2013; 146 (04) 841-847
  • 25 Borger MA, Peniston CM, Weisel RD, Vasiliou M, Green RE, Feindel CM. Neuropsychologic impairment after coronary bypass surgery: effect of gaseous microemboli during perfusionist interventions. J Thorac Cardiovasc Surg 2001; 121 (04) 743-749