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Scotti A, Sturla M, Granada JF, Kodali SK, Coisne A, Mangieri A, Godino C, Ho E, Goldberg Y, Chau M, Jorde UP, Garcia MJ, Maisano F, Bapat VN, Ailawadi G, Latib A. Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies. EUROINTERVENTION 2022; 18:840-851. [PMID: 36197445 PMCID: PMC10167545 DOI: 10.4244/eij-d-22-00442] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transcatheter tricuspid valve replacement (TTVR) is rapidly emerging as a therapeutic option amongst patients with secondary tricuspid regurgitation. Historical data from surgical tricuspid valve replacement (TVR) studies may serve as a benchmark for the development of TTVR trials. AIMS The aim of the study was to investigate the early and late outcomes following isolated surgical TVR. METHODS Multiple electronic databases were searched to identify studies on isolated surgical TVR. The prespecified primary endpoint was operative mortality; secondary endpoints were early and late outcomes. Overall estimates of proportions and incidence rates with 95% confidence intervals (CI) were calculated using random-effects models. Multiple sensitivity analyses accounting for baseline characteristics, country and the operative period were applied. Results: A total of 35 studies (5,316 patients) were included in this meta-analysis. The operative period ranged from 1974 to 2019. The overall rate of operative mortality was 12% (95% CI: 9-15), with higher mortality for patients who were operated on before 1995, who had prior cardiac surgeries, or who had liver disease. The most frequent clinical events were pacemaker implantation (10% [95% CI: 6-16]), bleeding (12% [95% CI: 8-17]), acute kidney injury (15% [95% CI: 9-24]) and respiratory complications (15% [95% CI: 12-20]). At follow-up analysis of the bioprosthetic TVR, there was an incidence rate per 100 person-years of 6 (95% CI: 2-13) for death and 8 (95% CI: 5-13) for recurrence of significant tricuspid regurgitation. CONCLUSIONS This meta-analysis provides an overview of the historical clinical outcomes following isolated surgical TVR. These findings can support the development of future clinical trials in the tricuspid space by providing thresholds for clinical outcomes.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Matteo Sturla
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan F Granada
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edwin Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ythan Goldberg
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Prosthesis choice for tricuspid valve replacement in the era of transcatheter valve-in-valve technique. J Thorac Cardiovasc Surg 2022. [DOI: 10.1016/j.jtcvs.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Chen J, Song W, Wei L. Risk stratification for isolated tricuspid valve surgery: Still on the way. JTCVS OPEN 2022; 11:89-90. [PMID: 36172433 PMCID: PMC9510854 DOI: 10.1016/j.xjon.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dai X, Teng P, Miao S, Zheng J, Si W, Zheng Q, Qin K, Ma L. Minimally Invasive Isolated Tricuspid Valve Repair After Left-Sided Valve Surgery: A Single-Center Experience. Front Surg 2022; 9:837148. [PMID: 35402491 PMCID: PMC8990026 DOI: 10.3389/fsurg.2022.837148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/01/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundTricuspid regurgitation after left-sided valve surgery was associated with terrible outcomes and high perioperative mortality for surgical treatment. In current years, minimally invasive isolated tricuspid valve repair is increasingly performed in our institution to address tricuspid regurgitation.MethodsThirty-seven consecutive patients with previous left-sided valve surgery underwent minimally invasive isolated tricuspid valve repair in our institution between November 2017 and December 2020. Twenty-nine patients(78.4%) were women and the mean age of patients was 58.4 ± 8.5 years. Follow-up was 100% complete with a mean follow-up time of 17.2 ± 9.5 months.ResultsBoth the in-hospital and 30-day mortalities were 2.7%. The overall NYHA class had improved significantly during the follow-up (p < 0.001). The grade of TR had decreased before discharge (p < 0.001) and during the follow-up (p < 0.001) compared with the preoperative level although severe TR was recurrent in one patient.ConclusionsMinimally invasive isolated tricuspid valve repair has acceptable early and midterm outcomes, may be the preferred surgical option to address tricuspid regurgitation after previous left-sided valve surgery when it is feasible.
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Affiliation(s)
- Xiaoyi Dai
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Peng Teng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Sihan Miao
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Junnan Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Si
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi Zheng
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- School of Medicine, Zhejiang University, Hangzhou, China
| | - Ke Qin
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liang Ma
- Department of Cardiovascular Surgery, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
- *Correspondence: Liang Ma
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Tricuspid Valve Prosthesis Choice: The Only Railroad to the Truth is to Conduct a Randomised Controlled Trial. Heart Lung Circ 2021; 30:321-323. [PMID: 33610282 DOI: 10.1016/j.hlc.2021.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Chen J, Hu K, Ma W, Lv M, Shi Y, Liu J, Wei L, Lin Y, Hong T, Wang C. Isolated reoperation for tricuspid regurgitation after left-sided valve surgery: technique evolution. Eur J Cardiothorac Surg 2021; 57:142-150. [PMID: 31157373 DOI: 10.1093/ejcts/ezz160] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/23/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES This study aimed to compare the isolated replacement and repair of severe tricuspid regurgitation after left-sided valve surgery (LSVS) and to report the evolution of this surgical technique. METHODS From January 2005 to August 2018, 118 patients underwent isolated tricuspid valve replacement (iTVR, n = 93) or repair (iTVr, n = 25) for severe tricuspid regurgitation after LSVS. The surgical protocol at our institution has significantly changed since 2015, implementing the right thoracotomy approach (95.5%) and peripheral cannulation strategy with the vacuum-assist single venous drainage technique (93.2%) with a concomitant enhancement in preoperative right heart function optimization. Patients were followed up for 32.5 ± 34.6 (1.6-158.7) months. RESULTS The operative mortality rate was 8.5% (8.6% in iTVR and 8.0% in iTVr, P = 0.924) with a significant decrease from 23.3% (2005-2014) to 3.4% (2015-2018) (P < 0.001), which was associated with preoperative New York Heart Association functional class IV [odds ratio (OR) 14.73, 95% confidence interval (CI) 2.68-80.90; P = 0.002] and anaemia (OR 6.60, 95% CI 1.03-42.22; P = 0.046). After adjusting the logistic regression model, the vacuum-assist single venous drainage technique was also associated with lower operative mortality and composite adverse outcomes. The overall 1- and 5-year survival rates were 91.5% (95% CI 84.8-95.3%) and 77.9% (95% CI 60.0-88.3%), respectively, and no difference was found between the iTVR and iTVr groups (P = 0.813). CONCLUSIONS Isolated tricuspid valve reoperation for severe tricuspid regurgitation after LSVS is historically a high-risk procedure, but satisfactory results are achievable with advanced surgical techniques and improved perioperative management. Bioprosthetic iTVR is a reliable alternative for severe tricuspid regurgitation after LSVS.
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Affiliation(s)
- Jinmiao Chen
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kui Hu
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiovascular Surgery, Guizhou Provincial People's Hospital, Guizhou, China
| | - Wenrui Ma
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Minzhi Lv
- Department of Biostatistics, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu Shi
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ju Liu
- Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yi Lin
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Tao Hong
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Chunsheng Wang
- Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai, China
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Yang L, Zhou K, Yang YC, He BC, Chen ZR, Tian CN, Huang HL. Outcomes of redo-isolated tricuspid valve surgery after left-sided valve surgery. J Card Surg 2021; 36:3060-3069. [PMID: 34125449 DOI: 10.1111/jocs.15694] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/23/2021] [Accepted: 05/24/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To compare early and long-term outcomes of redo-isolated tricuspid surgery (RITS) after left-sided valve surgery. METHODS We retrospectively reviewed 173 patients who underwent RITS for severe tricuspid regurgitation after previous left-sided valve surgery from January 1999 to December 2019. Patients were divided into two groups: RITS by median sternotomy (m-RITS; n = 78) and totally endoscopic approach (e-RITS; n = 95). Perioperative outcomes and follow-up results were analyzed. RESULTS There were 19 (11%) in-hospital deaths (14.1% in m-RITS and 8.4% in e-RITS, p = .234) that decreased from 16.7% (1999-2014) to 6.9% (2015-2019) (p = .044). Tricuspid valve replacement (odds ratio [OR] = 4.989, 95% confidence interval [CI]: 1.133-29.790, p = .041) and NYHA function class IV (OR = 9.611, 95% CI: 2.102-43.954, p = .004) were independent risk factors for in-hospital mortality. The overall 1-, 5-, 10-, and 15-year survival rates were 97.2% (95% CI: 94.5%-99.9%), 80.3% (95% CI: 71.7%-88.9%), 59.2% (95% CI: 43.5%-75.5%), and 49.3% (95% CI: 27.2%-71.4%), respectively. CONCLUSION Patients undergoing RITS carry a high risk of early mortality. There was no significant difference in early mortality or long-term survival between the endoscopy and median sternotomy, whereas the endoscopy approach was associated with shorter intensive care unit stays and fewer reoperations. Repair resulted in lower surgical mortality than replacement with acceptable residual tricuspid regurgitation.
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Affiliation(s)
- Liang Yang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Kan Zhou
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan-Chen Yang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Biao-Chuan He
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ze-Rui Chen
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Cheng-Nan Tian
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Huan-Lei Huang
- Department of Cardiovascular Surgery, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
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Chen J, Wei L, Wang C. The impact of minimally invasive technique on the outcomes of isolated tricuspid valve surgery. Eur Heart J 2021; 42:1926. [PMID: 33313740 DOI: 10.1093/eurheartj/ehaa966] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Jinmiao Chen
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Xuhui District, Shanghai 200032, China
| | - Lai Wei
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Xuhui District, Shanghai 200032, China
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, No.180 Fenglin Rd, Xuhui District, Shanghai 200032, China
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Mechanical Versus Bioprosthetic Valve Replacement in the Tricuspid Valve Position: A Systematic Review and Meta-Analysis. Heart Lung Circ 2021; 30:362-371. [DOI: 10.1016/j.hlc.2020.03.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 02/19/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
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10
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Tafti SHA, Alaeddini F, Shirzad M, Bagheri J, Omran AS, Mahalleh M, Shoja S, Omidi N. Isolated tricuspid valve surgery; long-term outcomes based on Tehran Heart Center data bank report. J Cardiothorac Surg 2021; 16:19. [PMID: 33622367 PMCID: PMC7903743 DOI: 10.1186/s13019-021-01394-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/16/2021] [Indexed: 11/21/2022] Open
Abstract
Background Given that isolated tricuspid valve (TV) repair or replacement is performed relatively rarely, we sought to evaluate the rate of long-term mortality and readmission following this surgery. Methods The current study was conducted in Tehran Heart Center on patients who underwent isolated TV repair or replacement between 2010 and 2018. Totally, 197 patients (repair = 150 vs replacement = 47) were included in our study and were then followed right after surgery for a median of 8 years to assess the incidence of postoperative events, readmission, and all-cause mortality. Results The final analysis was conducted on 197 patients at a mean age of 44.4 ± 13.8 years. Most of the patients were female (56.9%). Ejection fraction, TAPSE, and right ventricular function improved in both groups after TV surgery. Length of stay in the intensive care unit per hour and hospitalization per day were higher in the replacement group and compared to the repair group (158.34 vs. 55.11 and 18.21 vs. 9.34, respectively). In-hospital mortality occurred in 20 patients, of whom 15 had TV replacement. Readmission occurred in five (2.5%) patients,all were in the repair group. Conclusions The result of this single-center study showed that TV replacement is associated with a higher rate of postoperative events and all-cause mortality compared to TV repair. Whereas, repair group had a higher rate of readmission. Therefore, the overwhelming tendency is toward repair; nonetheless, no hesitation is permissible if a replacement is adjudged to confer a better outcome for the patient.
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Affiliation(s)
| | - Farshid Alaeddini
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Shirzad
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Salehi Omran
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Mahalleh
- Cardiovascular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Shoja
- Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Negar Omidi
- Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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Flagiello M, Grinberg D, Connock M, Armoiry X, Buzzi R, Thibault H, Uhlrich W, Jacquet-Lagreze M, Fellahi JL, Obadia JF, Pozzi M. Beating versus arrested heart isolated tricuspid valve surgery: An 11-year experience in the current era. J Card Surg 2021; 36:1020-1027. [PMID: 33522662 DOI: 10.1111/jocs.15390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/14/2020] [Accepted: 12/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIM OF THE STUDY Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. METHODS We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross-clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in-hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity-score matching. RESULTS From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In-hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36-10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36-9.97). Age was the only predictor of in-hospital mortality. CONCLUSIONS The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.
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Affiliation(s)
| | - Daniel Grinberg
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Martin Connock
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Xavier Armoiry
- Pharmacy Department, School of Pharmacy (ISPB)/UMR CNRS 5510 MATEIS/Edouard Herriot Hospital, University of Lyon, Lyon, France.,University of Warwick Medical School, Coventry, UK
| | - Remi Buzzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Helene Thibault
- Department of Cardiology, Louis Pradel Cardiologic Hospital, Lyon, France
| | - William Uhlrich
- Department of Cardiology, Louis Pradel Cardiologic Hospital, Lyon, France
| | | | - Jean L Fellahi
- Department of Anesthesia and ICU, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Jean F Obadia
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
| | - Matteo Pozzi
- Department of Cardiac Surgery, Louis Pradel Cardiologic Hospital, Lyon, France
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Lu S, Song K, Yao W, Xia L, Dong L, Sun Y, Hong T, Yang S, Wang C. Simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery. J Cardiothorac Surg 2020; 15:146. [PMID: 32552843 PMCID: PMC7301080 DOI: 10.1186/s13019-020-01192-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 06/08/2020] [Indexed: 11/13/2022] Open
Abstract
Background Redo isolated tricuspid valve surgery is associated with a high morbidity and mortality, and its optimal timing remains controversial. Hence, here we reviewed the early and midterm results of simplified, minimally invasive, beating-heart technique for redo isolated tricuspid valve surgery in patients at high risk. Methods A total of 32 consecutive patients underwent a redo isolated tricuspid valve surgery using minimally invasive, beating-heart technique through a right lateral thoracotomy in our center between June 2016 and April 2020. The mean age of patients was 57.4 ± 8.3 years, and 18 patients (56.3%) were women. The mean preoperative EuroSCORE was 7.8 ± 1.4 (range: 6–11). Follow-up was 87.1% complete, with a mean duration of 26.3 ± 12.3 months. Results Both in-hospital and 30-day mortalities were 3.1%. Tricuspid valve replacement with bioprosthesis was performed in 30 patients (93.8%), and the remaining two patients (6.2%) underwent tricuspid repair (annuloplasty and leaflet reconstruction). The mean cardiopulmonary bypass time was 81.5 ± 29.0 min. The overall in-hospital duration and intensive care unit (ICU) times were 13.6 ± 7.6 days and 4.1 ± 2.8 days, respectively. Postoperative complications included prolonged ventilation in six patients (18.8%), acute kidney injury in three patients (9.4%), and neurologic event, wound infection, or permanent third-degree atrioventricular block, in one patient (3.1%) each. A total of 96.9% patients were discharged uneventfully. Four patients were lost to follow-up; there were no midterm deaths in patients who were followed up. Conclusions Simplified, minimally invasive, beating-heart technique for redo tricuspid valve surgery is both feasible and safe, and the early and midterm results are excellent.
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Affiliation(s)
- Shuyang Lu
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Kai Song
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Wangchao Yao
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Limin Xia
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Yongxin Sun
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Tao Hong
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China
| | - Shouguo Yang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China.
| | - Chunsheng Wang
- Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, The Shanghai Institute of Cardiovascular Diseases, No. 1609 Xietu Road, Xuhui District, Shanghai, 200032, China.
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