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.
Keywords
valve surgery - reoperation - cardiopulmonary bypass
