Concomitant Tricuspid Valve Repair during Minimally Invasive Mitral Valve Repair

Abstract Background Concomitant use of tricuspid valve (TV) surgery and minimally invasive mitral valve (MV) repair is debatable due to a prolonged time of surgery with presumably elevated operative risk. Herein, we examined cardiopulmonary bypass times and 30-day mortality in patients who underwent MV repair with and without concomitant TV surgery. Methods We retrospectively evaluated 3,962 patients with MV regurgitation who underwent minimally invasive MV repair without (n = 3,463; MVr group) and with (n = 499; MVr + TVr group) concomitant TV surgery between 1999 and 2014. Preoperative parameters between the groups were significantly different; therefore, propensity score matching was performed. Results Mean cardiopulmonary bypass time for all patients was 125.5 ± 55.8 minutes in MVr and 162.0 ± 58.0 minutes in MVr + TVr (p < 0.001). Overall 30-day mortality was significantly different between these groups (4.8 vs. 2.1%; p < 0.001); however, after adjustment, there was no significant difference (3.3 vs. 1.2%; p = 0.07). Backward logistic regression revealed that cardiopulmonary bypass time was not a significant predictor for early mortality within the MVr + TVr cohort. Conclusion Concomitant TV repair using prosthetic rings through a minimally invasive approach is safe and does not lead to elevated early mortality in our patient cohort. Therefore, prolonged cardiopulmonary bypass time should not be the sole reason to rule out MV repair with concomitant TV repair and to prefer the use of suture techniques, which saves only a few minutes compared with prosthetic ring implantation.

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Right Minithoraсotomy as a Standard Approach for Mitral Valve Surgery

Ukrainian journal of cardiovascular surgery ◽

10.30702/ujcvs/20.3803/013023-028 ◽

2020 ◽

pp. 23-28

Author(s):

O. D. Babliak ◽

V. M. Demianenko ◽

D. Y. Babliak ◽

A. I. Marchenko ◽

K. A. Revenko ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Standard Approach ◽

Wound Complications ◽

Tricuspid Valve Repair ◽

Valve Repair

Background. Minimally invasive mitral valve surgery provides many advantages for patients. The aim. To investigate and represent our own experience in minimally invasive mitral valve surgery, and to describe the operative technique. Materials and methods. The study was included 100 consecutive patients who underwent a minimally invasive mitral valve repair or replacement through the right lateral minithoracotomy from June 2017 to December 2019. Results. Mitral valve repair was performed in 87 patients (87%), and 13 patients (13%) were required mitral valve replacement. In 24 patients (24%), concomitant procedures were performed: tricuspid valve repair, atrial septal defect repair and left atrial myxomectomy. Ring anuloplasty was performed in all patients who underwent mitral valve repair. Additional methods of correction were used in accordance to the lesion anatomy: neochords implantation, cleft and leaflet perforation closure, leaflet resection, Alfieri (edge-to-edge) stitch, posterior leaflet plication. There was no in-hospital and 30-day mortality. Post-operative strokes were not reported. No wound complications were observed in the femoral cannulation area. The total length of stay in a hospital was 6 ± 1.46 (3–9) days. There were no cases of mitral valve insufficiency greater more than mild degree after mitral valve repair at the time of discharge. Conclusions. Minimally invasive mitral valve surgery can be performed as a routine standard approach, provides safe and effective correction of the mitral valve defects, allows excellent results of mitral valve repair and replacement in various abnormalities. Minimally invasive approach enables to perform a large number of reconstructive valve techniques and perform simultaneous correction of atrial septal defects, tricuspid valve repair and atrial neoplasm removal.

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Does Concomitant Tricuspid Valve Repair Elevate the Operative Risk Due to Prolonged Time of Surgery in Patients with Minimally Invasive Mitral Valve Repair?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1598676 ◽

2017 ◽

Vol 65 (S 01) ◽

pp. S1-S110

Author(s):

B. Pfannmüller ◽

P. Davierwala ◽

M. Misfeld ◽

F. Bakhtiary ◽

F.-W. Mohr

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Tricuspid Valve ◽

Operative Risk ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Time Of Surgery ◽

Prolonged Time

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Concomitant Tricuspid Valve Repair in Minimally Invasive Mitral Valve Surgery

Heart Lung and Circulation ◽

10.1016/j.hlc.2018.04.263 ◽

2018 ◽

Vol 27 ◽

pp. S593

Author(s):

Anh Vo ◽

Dinh Nguyen ◽

Trang Nguyen ◽

Huy Ngo ◽

Thien Vu ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0033-1333844 ◽

2013 ◽

Vol 61 (05) ◽

pp. 386-391 ◽

Cited By ~ 13

Author(s):

Alexander Verevkin ◽

Michael Borger ◽

Meinhard Mende ◽

Piroze Davierwala ◽

Jens Garbade ◽

...

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Tricuspid Valve Repair ◽

Valve Repair

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Use of an automated knot fastener shortens operative times in minimally invasive mitral valve repair

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2019.0063 ◽

2019 ◽

Vol 101 (7) ◽

pp. 522-528 ◽

Cited By ~ 3

Author(s):

G Perin ◽

M Shaw ◽

V Pingle ◽

K Palmer ◽

O Al-Rawi ◽

...

Keyword(s):

Renal Failure ◽

Cardiopulmonary Bypass ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Valve Repair ◽

Postoperative Outcomes ◽

Valve Repair ◽

Aortic Cross Clamp ◽

Logistic Euroscore ◽

Significant Difference

Introduction Longer durations of cardiopulmonary bypass and aortic cross clamp are associated with increased morbidity and mortality. Little is known about the effect of automated knot fasteners (Cor-Knot®) in minimally invasive mitral valve repair on operative times and outcomes. The aim of this study was to evaluate whether these devices shortened cardiopulmonary bypass and aortic cross clamp times and whether this impacted on postoperative outcomes. Materials and methods All patients undergoing isolated minimally invasive mitral valve repair by a single surgeon between March 2011 and March 2016 were included (n = 108). Two cohorts were created based on the use (n = 52) or non-use (n = 56) of an automated knot fastener. Data concerning intraoperative variables and postoperative outcomes were collected and compared. Results Preoperative demographics were well matched between groups with no significant difference in logistic Euroscore (manual vs automated: median 3.1, interquartile range, IQR, 2.1–5.5, vs 5.4, IQR 2.2–8.3; P = 0.07, respectively). Comparing manually tied knots to an automated fastener, cardiopulmonary bypass and aortic cross clamp times were significantly shorter in the automated group (cardiopulmonary bypass: median 200 minutes, IQR 180–227, vs 165 minutes (IQR 145–189 minutes), P < 0.001; aortic cross clamp 134 minutes (IQR 121–150 minutes) vs 111 minutes (IQR 91–137 minutes), P < 0.001, respectively). There was no mortality and no strokes, nor were there any differences in postoperative outcomes including reoperation for bleeding, renal failure, intensive care or hospital stay. Conclusions The use of an automated knot fastener significantly reduces cardiopulmonary bypass and aortic cross clamp times in minimally invasive mitral valve repair but this does not translate into an improved clinical outcome.

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Anaesthetic Management for Minimally Invasive approach for ASD closure, Mitral valve replacement and Tricuspid valve repair in a patient with Lutembacher syndrome

Journal of Medical Science And clinical Research ◽

10.18535/jmscr/v8i3.01 ◽

2020 ◽

Vol 08 (03) ◽

Author(s):

Iris Eapen ◽

Keyword(s):

Mitral Valve ◽

Minimally Invasive ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Anaesthetic Management ◽

Tricuspid Valve Repair ◽

Valve Repair ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Asd Closure

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Clinical outcome in elderly patients undergoing mitral valve repair with or without tricuspid valve repair

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1367108 ◽

2014 ◽

Vol 62 (S 01) ◽

Author(s):

A. Renner ◽

A. Zittermann ◽

A. Aboud ◽

K. Hakim ◽

J. Börgermann ◽

...

Keyword(s):

Mitral Valve ◽

Clinical Outcome ◽

Elderly Patients ◽

Mitral Valve Repair ◽

Tricuspid Valve ◽

Tricuspid Valve Repair ◽

Valve Repair

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Video-assisted minimal access surgery for complicated mitral valve endocarditis, tricuspid valve insufficiency and progressive coronary disease after previous CABG - in the time of COVID-19: a case report

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-021-01517-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Terézia B. Andrási ◽

Nunijiati Abudureheman ◽

Alannah Glück ◽

Maximilian Vondran ◽

Gerhard Dinges ◽

...

Keyword(s):

Cardiac Surgery ◽

Mitral Valve ◽

Minimally Invasive ◽

Tricuspid Valve ◽

Surgical Instruments ◽

Tricuspid Valve Repair ◽

Long Term Outcome ◽

Tricuspid Valve Insufficiency ◽

Valve Insufficiency ◽

Neurosurgical Intervention

Abstract Background The timing for heart surgery following cerebral embolization after cardiac valve vegetation is vital to postoperative recovery being uneventful, additionally Covid-19 may negatively affect the outcome. Minimally invasive methods and upgraded surgical instruments maximize the benefits of surgery also in complex cardiac revision cases with substantial perioperative risk. Case presentation A 68 y.o. patient, 10 years after previous sternotomy for OPCAB was referred to cardiac surgery on the 10th postoperative day after neurosurgical intervention for intracerebral bleeding with suspected mitral valve endocarditis. Mitral valve vegetation, tricuspid valve insufficiency and coronary stenosis were diagnosed and treated by minimally invasive revision cardiac surgery on the 14th postoperative day after neurosurgery. Conclusion The present clinical case demonstrates for the first time that the minimally invasive approach via right anterior mini-thoracotomy can be safely used for concomitant complex mitral valve reconstruction, tricuspid valve repair and aorto-coronary bypass surgery, even as a revision procedure in the presence of florid endocarditis after recent neurosurgical intervention. The Covid-19 pandemic and prophylactic patient isolation slow down the efficacy of pulmonary weaning and mobilisation and prolong the need for ICU treatment, without adversely affecting long-term outcome.

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Tricuspid Valve Repair for the Poor Right Ventricle: Tricuspid Valve Repair in Patients with Mild-to-Moderate Tricuspid Regurgitation Undergoing Mitral Valve Repair Improves In-Hospital Outcome

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0034-1399783 ◽

2015 ◽

Vol 65 (08) ◽

pp. 612-616 ◽

Cited By ~ 2

Author(s):

Michele Genoni ◽

Kirk Graves ◽

Dragan Odavic ◽

Helen Löblein ◽

Achim Häussler ◽

...

Keyword(s):

United States ◽

Mitral Valve ◽

Blood Transfusion ◽

Right Ventricle ◽

Tricuspid Valve ◽

Tricuspid Regurgitation ◽

Operation Time ◽

Tricuspid Valve Repair ◽

Cell Saver ◽

Valve Repair

Background Tricuspid regurgitation (TR) in patients undergoing surgery for mitral valve (MV) increases morbidity and mortality, especially in case of a poor right ventricle. Does repair of mild-to-moderate insufficiency of the tricuspid valve (TV) in patients undergoing MV surgery lead to a benefit in early postoperative outcome? Methods A total of 22 patients with mild-to-moderate TR underwent MV repair and concomitant TV repair with Tri-Ad (Medtronic ATS Medical Inc., Minneapolis, Minnesota, United States) and Edwards Cosgrove (Edwards Lifesciences Irvine, California, United States) rings. The severity of TR was assessed echocardiographically by using color-Doppler flow images. The tricuspid annular plane systolic excursion (TAPSE) was under 1.7 cm. Additional procedures included coronary artery bypass (n = 9) and maze procedure (n = 15). The following parameters were compared: postoperative and peak dose of noradrenaline (NA), pre/postoperative systolic pulmonary pressure (sPAP), extubation time, operation time, cross-clamp time, cardiopulmonary bypass (CPB) time, pre/postoperative ejection fraction (EF), intensive care unit (ICU)-stay, hospital stay, cell saver blood transfusion, intra/postoperative blood transfusion, and postoperative TR. Results The mean age was 67 ± 14.8 years, 45% were male. Mean EF was 47 ± 16.2%, postoperative 52 ± 12.4%. sPAP was 46 ± 20.1 mm Hg preoperatively, sPAP was 40.6 ± 9.4 mm Hg postoperatively, NA postoperatively was 12 ± 10 μg/min, NA peak was 18 ± 11 μg/min, operation time was 275 ± 92 minutes, CPB was 145 ± 49 minutes, ICU stay was 2.4 ± 2.4 days, hospital stay was 10.8 ± 3.5 days, cell saver blood transfusion was 736 ± 346 mL, intraoperative transfusions were 2.5 ± 1.6. Two patients needed postoperative transfusions. A total of 19 patients were extubated at the 1st postoperative day, 2 patients at the 2nd day, and 1 at the 4th postoperative day. Two patients required a pacemaker. No reintubation, no in-hospital mortality, and one reoperation because of bleeding complications. Conclusion Correction of mild-to-moderate TR at the time of MV repair does maintain TV function and avoid right ventricular dysfunction in the early postoperative period improving the clinical outcome.

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