Isolated Tricuspid Valve Surgery: A Single Institutional Experience with the Technique of Minimally Invasive Surgery via Right Minithoracotomy.

Background Minimally invasive cardiac surgery via right lateral minithoracotomy is a well-described approach. However, reports on isolated tricuspid valve surgery (TVS) in this technique are rare. Therefore, we like to give a contribution by reporting our experience. Methods We retrospectively reviewed 25 tricuspid valve operations via right lateral minithoracotomy with femoral cannulation between August 2009 and September 2013 (18 repairs, 7 replacements, and 72% repair rate). Three patients (12%) presented for a re-do operation, and nine patients (36%) suffered from active endocarditis at admission. All patients underwent TVS as single valve procedure. Ten patients received additional procedures such as removal of infected leads, resection of atrial tumors, or closure of atrial septal defects. An annuloplasty ring was inserted in 12 cases. We investigated the short-term morbidity and mortality with regard to the surgical procedure. Results Repair rate was 72%. Thirty-day and 1-year mortality were 4 and 20%, respectively. The only patient with early mortality received the surgical procedure on the tricuspid valve as fourth cardiac-related surgery and postoperative mortality was due to intracranial air embolism. Perioperative morbidity included reoperation for bleeding (8%) and stroke (4%). No disturbance of wound healing occurred. Durations of intensive care unit stay and hospital stay were 2.3 ± 2.4 and 17.4 ± 13.1 days, respectively. Endocarditis-caused surgery did not reveal any significant difference in the intra- or perioperative course compared with other indications. Conclusion Minimally invasive TVS via right lateral minithoracotomy is feasible with good results. Even in a cohort of patients suffering from elevated rate of active endocarditis, a high repair rate can be achieved.

Effectiveness of A Four-Week Diet Regimen, Exercise and Psychological Intervention for Weight Loss.

INTRODUCTION: Obesity is accompanied by restriction in the quality of life and an increased risk of morbidity and mortality. Cardiovascular, orthopedic, and metabolic disorders are among the possible consequences. In the management of obesity, a combination therapy that includes dietary, exercise, and behaviour modules has proven its worth. AIM: To evaluate the effect of weight-associated parameters, circulation associated parameters, glucose metabolism, body composition and life quality changes within a four-week inpatient rehabilitation program. MATERIALS AND METHODS: Fifty-two patients underwent a 4-week inpatient rehabilitation program consisting of nutrition therapy, behavioural therapy and exercise therapy modules at the Eleonoren Clinic of Winterkasten, Germany. RESULTS: The mean weight reduction of 52 obese patients 40 (76.9%) males, 12 (23.1%) females; mean age 46 years; mean Body Mass Index (BMI) 43,79 kg/m2) achieved was 7.1 kg (from 1.20 kg to 17.50 kg), and the BMI reduction was 2.3 kg/m2 (from 0.40 kg/m2 to 5.40 kg/m2). The excessive weight loss was highly significant (p<0.001). Weight reduction was accompanied by an improvement in the diabetic metabolic state (lowering of fasting blood-glucose 20 mg/dl, postprandial blood glucose 26 mg/dl, HbA1c 0.27%). In all 73% of the patients suffered from arterial hypertonia. The significant mean decline of systolic and diastolic blood pressure was 12.8 mmHg and 6.8 mmHg, respectively. The resting pulse was reduced by an average of 11 beats per minute. The Bioelectric Impedance Analysis (BIA) revealed a significant reduction of body fat content (p<0.001). The subjective impression of impaired life quality (SF-36 questionnaire) improved significantly. CONCLUSION: The study clearly shows that the inpatient rehabilitation program at the Eleonoren Clinic was suitable to enhance the physical and mental state of people with obesity. In a two-year follow-up program the patients should take care of a permanent lifestyle change toward an improved dietary, movement and health behaviour.

Single-centre experience of mitral valve surgery via right lateral mini-thoracotomy in octogenarians.

OBJECTIVES: According to demographic changes in the industrialized world, the average age of patients referred to cardiac surgery is increasing. These patients typically display numerous comorbidities, associated with increased perioperative risk. Therefore, the indication for a catheter-based therapy is progressively extended, including interventions on the mitral valve (MV). In this context, we evaluated a contemporary series of octogenarians undergoing minimally invasive MV surgery at our institution using right lateral minithoracotomy to elucidate the preoperative risk profile and the postoperative course in this particular cohort. METHODS: Between October 2009 and October 2014, 34 patients aged 80 years and older (82.5 ± 2.0) undergoing minimally invasive MV surgery were identified with a subgroup of 15 patients (44.1%) receiving concomitant surgery on the tricuspid valve (TV). We analysed the preoperative profile, perioperative course and functional outcome. RESULTS: Preoperative comorbidities included insulin-dependent diabetes mellitus (17.6%), COPD (17.6%), active endocarditis (2.9%) and previous neurological events (2.9%). The mean left ventricular ejection fraction was 59.7 ± 6.9%. Mean European System for Cardiac Outcome Risk Evaluation II was 5.2 ± 5.3%. The repair rate of all treated MVs and TVs in isolated and combined procedures was 81.6% (73.5% for MV and 100.0% for TV surgery). Postoperatively, 4 patients (11.8%) required new-onset intermittent haemodialysis. Prolonged ventilation (>12 h) was necessary in 9 patients (26.5%). The 30-day mortality rate was 5.9%. CONCLUSIONS: Minimally invasive right lateral MV surgery in octogenarians results in favourable outcomes. Therefore, MV surgery represents a valid option in this cohort, providing established and durable concepts of valve reconstruction.