Cirugía tricúspide aislada sin clampaje aórtico por minitoracotomía derecha

Background

Tricuspid valve disease has been steadily increasing, raising concerns about the morbidity and mortality associated with surgery when performed via conventional sternotomy. In this context, the clinical and aesthetic advantages of isolated tricuspid surgery by right anterior mini-thoracotomy without aortic clamping are presented.

Material and methods

A case series of 29 patients who underwent minimally invasive isolated tricuspid valve surgery in our center, from 2014 to 2023, have been studied retrospectively. The operation was performed by right anterior mini-thoracotomy without caval exclusion and without aortic clamping to a beating heart assisted by 3 D videothoracoscopy. Preoperative levosimendan was administered in patients with severe pulmonary hypertension and/or right ventricular dysfunction.

Results

Twenty-eight tricuspid valve replacement and one repair were performed. Average patients age was 63 years old (SD 8 years old). 18 patients (62%) had previous cardiac surgery. 22 patients (75,8%) had severe pulmonary hypertension and 12 (41,3%) had right ventricule disfunction. Average EuroSCORE II was 4,10%. In-hospital mortality was 3,4% (one patient). The average extracorporeal circulation was 109 (SD 41 minutes). There was a reoperation due bleeding and a permanent pacemaker implantation (3,4%). Temporary renal replacement therapy was required in 21% (6 patients). The median length of hospital stay was 7 days.

Conclusions

Minimally invasive isolated tricuspid valve surgery is a safe technique as a definitive treatment of isolated tricuspid valve disease with a low mortality and morbidity.