Operative Outcomes of Concomitant Minimally Invasive Mitral and Tricuspid Valve Surgery

• Published in: Innovations (Philadelphia, Pa.) Pa.), 2019-10, Vol.14 (5), p.412-418
• Main Authors: Kilic, Arman, Szeto, Wilson Y., Atluri, Pavan, Acker, Michael A., Clark Hargrove, W.
• Format: Article
• Language: English
• Subjects: Aged; Cardiac Valve Annuloplasty - methods; Cardiac Valve Annuloplasty - mortality; Case-Control Studies; Female; Humans; Male; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Mitral Valve - surgery; Mitral Valve Insufficiency - surgery; Retrospective Studies; Treatment Outcome; Tricuspid Valve - surgery; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - surgery
• ISSN: 1556-9845; 1559-0879
• DOI: 10.1177/1556984519864939

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.