MINIMALLY INVASIVE TRICUSPIDE VALVE SURGERY WITHOUT CAVAL OCCLUSION:
SHORT AND MID-TERM RESULTS.
Abstract
Abstract Objectives: The use of minimally invasive or transcatheter
interventions rather than standard full sternotomy operations to treat
Tricuspid valve disease is increasing. Debate however is still open
regarding venous drainage management during cardiopulmonary bypass and
wheatear or not superior and inferior vena cava should be occluded
during opening of the right atrium to avoid air entrance in the venous
line. The aim of the present study is to report operative outcomes and
mid-term follow-up results of minimally invasive tricuspid valve surgery
performed without caval occlusion. Methods: This is a retrospective
outcome evaluation from institutional records with prospective data
entry. We searched for all the patients who underwent right
mini-thoracotomy tricuspid valve surgery isolated or combined with
mitral valve surgery during the period June 2013 – February 2020.
Results: During the study period 68 consecutive patients underwent
minimally invasive tricuspid valve surgery without occlusion of cava
veins. Survival at a 5-year and 8-year follow up was 100% and 79%,
respectively. At follow-up no patient had an NHYA class greater than
two, only one patient was re-hospitalized for heart failure for an
atrial fibrillation episode. One patient was hospitalized for a
pericardiocentesis twenty days after discharge No severe tricuspid
regurgitation was evident at echocardiographic follow up. Five patients
had 2+ TR. Conclusion Our results show that performing tricuspid surgery
without caval occlusion is safe. There is no clinical evidence of gas
embolism. Mid-term follow up data confirm that minimally invasive
approach does not alter the quality of surgery.