Postoperative Results of Patients Undergoing Minimally Invasive Tricuspid Valve Procedure

Abstract

Background

Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right minithoracotomy offers a less invasive option for the treatment of tricuspid valve insufficiency compared with conventional sternotomy approach.

Methods

We present our postoperative results regarding the two different surgical approaches.

Results

From 2017 to 2021, 180 patients underwent isolated or combined tricuspid valve procedures in our heart center, either through median sternotomy (n = 152, group 1) or via MIC approach (n = 28, group 2). Mean age was 68 ± 11 years in group 1 and 69 ± 11 years in group 2. A propensity matching analysis was performed comparing 21 patients from each group. The majority of the patients in both groups received tricuspid valve repair (90% in unmatched group 1 and 79% in unmatched group 2). Tricuspid valve replacement was performed in 10% of group 1 versus 21% of group 2. The 30-day mortality was higher in matched group 1 patients (14%) in comparison to matched group 2 patients (5%; odds ratio [OR] = 3.00; [0.31, 28.84]; p = 0.341). Mean required packed red blood cells was 9.43 ± 11.79 units in group 1, respectively, 3.57 ± 4.75 units in group 2 (OR = 1.12; [0.98, 1.29]; p = 0.099). Postoperative echocardiography revealed excellent tricuspid valve function in both matched groups.

Conclusion

Video-assisted minimally invasive (MIC) tricuspid valve repair or replacement through right mini-thoracotomy is a good alternative to sternotomy approach. Our postoperative results demonstrate that MIC approach is safe and feasible.

Keywords

minimally invasive - video-assisted - right minithoracotomy - tricuspid valve repair - tricuspid valve replacement

Publication History

Received: 29 May 2025

Accepted: 17 November 2025

Accepted Manuscript online:
19 November 2025

Article published online:
04 December 2025

• References

• 1 Abdelbar A, Kenawy A, Zacharias J. Minimally invasive tricuspid valve surgery. J Thorac Dis 2021; 13 (03) 1982-1992
• 2 Brescia AA, Ward ST, Watt TMF. et al; Michigan Mitral Research Group (MMRG). Outcomes of guideline-directed concomitant annuloplasty for functional tricuspid regurgitation. Ann Thorac Surg 2020; 109 (04) 1227-1232
• 3 Möllmann H, von Bardeleben RS, Dreger H. et al. Trikuspidalklappeninsuffizienz: DGK-Positionspapier. Kardiologe 2022; 16 (05) 372-382
• 4 Offen S, Playford D, Strange G, Stewart S, Celermajer DS. Adverse prognostic impact of even mild or moderate tricuspid regurgitation: insights from the National Echocardiography Database of Australia. J Am Soc Echocardiogr 2022; 35 (08) 810-817
• 5 Hahn RT, Lawlor MK, Davidson CJ. et al; TVARC Steering Committee. Tricuspid valve academic research consortium definitions for tricuspid regurgitation and trial endpoints. J Am Coll Cardiol 2023; 82 (17) 1711-1735
• 6 Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol 2004; 43 (03) 405-409
• 7 Otto CM, Nishimura RA, Bonow RO. et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines. Circulation 2021; 143 (05) e72-e227
• 8 Paparella D, Fattouch K, Moscarelli M. et al. Current trends in mitral valve surgery: a multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol 2020; 306: 147-151
• 9 Hawkins RB, Mehaffey JH, Kessel SM. et al. Minimally invasive mitral valve surgery is associated with excellent resource utilization, cost, and outcomes. J Thorac Cardiovasc Surg 2018; 156 (02) 611-616.e3
• 10 Qiu Z, Chen X, Xu Y. et al. Does full sternotomy have more significant impact than the cardiopulmonary bypass time in patients of mitral valve surgery?. J Cardiothorac Surg 2018; 13 (01) 29
• 11 Sakaguchi T. Minimally invasive mitral valve surgery through a right mini-thoracotomy. Gen Thorac Cardiovasc Surg 2016; 64 (12) 699-706
• 12 Lee R, Li S, Rankin JS. et al; Society of Thoracic Surgeons Adult Cardiac Surgical Database. Fifteen-year outcome trends for valve surgery in North America. Ann Thorac Surg 2011; 91 (03) 677-684 , discussion 684
• 13 Rankin JS, Hammill BG, Ferguson Jr TB. et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg 2006; 131 (03) 547-557
• 14 Kilic A, Szeto WY, Atluri P, Acker MA, Clark Hargrove W. Operative outcomes of concomitant minimally invasive mitral and tricuspid valve surgery. Innovations (Phila) 2019; 14 (05) 412-418
• 15 Paparella D, Margari V, Santarpino G. et al. Comparison of a full sternotomy with a minimally invasive approach for concomitant mitral and tricuspid valve surgery. Eur J Cardiothorac Surg 2022; 62 (03) ezac167
• 16 Abdelbar A, Niranjan G, Tynnson C. et al. Endoscopic tricuspid valve surgery is a safe and effective option. Innovations (Phila) 2020; 15 (01) 66-73
• 17 Tugtekin S-M, Schöne P, Alexiou K, Matschke K, Kappert U, Wilbring M. Aktuelle Weiterentwicklungen und Fortschritte in der Herzchirurgie. kardio-u2d 2023; 19 (03) 229-243
• 18 Lin Z, Xu Z, Chen X, Lin F, Chen L, Dai X. Safety and efficacy of total thoracoscopic surgery for patients with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement: a retrospective comparative study. BMC Cardiovasc Disord 2023; 23 (01) 400
• 19 Maimaiti A, Wei L, Yang Y, Liu H, Wang C. Benefits of a right anterolateral minithoracotomy rather than a median sternotomy in isolated tricuspid redo procedures. J Thorac Dis 2017; 9 (05) 1281-1288