Sage Journals: Discover world-class research

Abstract

Objective

The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS).

Methods

Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay.

Results

A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable.

Conclusions

Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.

Keywords

tricuspid valve mitral valve stroke outcomes minimally invasive surgery

Get full access to this article

View all access options for this article.

References

Nishimura

RA.

Otto

CM.

Bonow

et al. AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 2014: e521–e643.

Badhwar

Rankin

JS.

et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg 2017; 103: 587–593.doi:10.1016/j.athoracsur.2016.06.004

LaPar

DJ.

Mulloy

DP.

Stone

et al. Concomitant tricuspid valve surgery affects outcomes following mitral operations: a multi-institutional, statewide analysis. Ann Thorac Surg 2012; 94: 52–58.doi:10.1016/j.athoracsur.2012.03.020

Cohn

LH.

Adams

DH.

Couper

et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226: 421–426.doi:10.1097/00000658-199710000-00003

Navia

JL.

Cosgrove

. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62: 1542–1544.doi:10.1016/0003-4975(96)00779-5

Chikwe

Itagaki

Anyanwu

et al. Impact of concomitant tricuspid annuloplasty on tricuspid regurgitation, right ventricular function, and pulmonary artery hypertension after repair of mitral valve prolapse. J Am Coll Cardiol 2015; 65: 1931–1938.doi:10.1016/j.jacc.2015.01.059

Mihos

CG.

Pineda

AM.

Davila

et al. Combined mitral and tricuspid valve surgery performed via a right minithoracotomy approach. Innovations (Phila) 2015; 10: 304–308.doi:10.1097/imi.0000000000000191

Pfannmüller

Davierwala

Hirnle

et al. Concomitant tricuspid valve repair in patients with minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013; 2: 758–764.doi:10.3978/j.issn.2225-319X.2013.10.01

Glauber

Miceli

Canarutto

et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg 2015; 10: 181.doi:10.1186/s13019-015-0390-y

10.

Sündermann

SH.

Sromicki

Rodriguez Cetina Biefer

et al. Mitral valve surgery: right lateral minithoracotomy or sternotomy? A systematic review and meta-analysis. J Thorac Cardiovasc Surg 2014; 148: 1989–1995.doi:10.1016/j.jtcvs.2014.01.046

11.

Wei

et al. Analysis of the learning curve in mitral valve replacement through the right anterolateral minithoracotomy approach: a surgeon’s experience with the first 100 patients. Heart Lung Circ 2019; 28: 471–476.doi:10.1016/j.hlc.2018.02.002

12.

Holzhey

DM.

Seeburger

Misfeld

et al. Learning minimally invasive mitral valve surgery: a cumulative sum sequential probability analysis of 3895 operations from a single high-volume center. Circulation 2013; 128: 483–491.doi:10.1161/CIRCULATIONAHA.112.001402

13.

Greason

KL.

Lahr

BD.

Stulak

et al. Long-term mortality effect of early pacemaker implantation after surgical aortic valve replacement. Ann Thorac Surg 2017; 104: 1259–1264.doi:10.1016/j.athoracsur.2017.01.083

14.

Chamandi

Barbanti

Munoz-Garcia

et al. Long-term outcomes in patients with new permanent pacemaker implantation following transcatheter aortic valve replacement. JACC Cardiovasc Interv 2018; 11: 301–310.doi:10.1016/j.jcin.2017.10.032

15.

Jokinen

JJ.

Turpeinen

AK.

Pitkänen

et al. Pacemaker therapy after tricuspid valve operations: implications on mortality, morbidity, and quality of life. Ann Thorac Surg 2009; 87: 1806–1814.doi:10.1016/j.athoracsur.2009.03.048

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.12 MB