Minimally Invasive, Isolated Tricuspid Valve Redo Surgery: A Safety and Outcome Analysis.
Thorac Cardiovasc Surg
; 66(7): 564-571, 2018 10.
Article
en En
| MEDLINE
| ID: mdl-29672815
ABSTRACT
BACKGROUND:
Isolated tricuspid valve (TV) surgery is considered a high risk-procedure. The optimal surgical approach is controversial. We analyzed our experience with isolated TV redo surgery performed either minimally invasively (redo-MITS) or through sternotomy.METHODS:
We retrospectively analyzed all patients with previous cardiac surgery who underwent redo-MITS (n = 26) and compared them to redo-Sternotomy (n = 17). A group of primary-MITS (n = 61) served as control.RESULTS:
The redo-MITS approach consisted of a right anterolateral mini-thoracotomy, transpericardial right atrial access, and beating heart TV surgery without caval occlusion. Redo-MITS patients were oldest and had the most comorbidities (EuroScore II 9.83 ± 6.05% versus redo-Sternotomy 8.42 ± 7.33% versus primary-MITS 4.15 ± 4.84%). There were no intraoperative complications or conversions to sternotomy in both MITS groups. Redo-Sternotomy had the highest 30-day mortality (24%), the poorest long-term survival, and the highest perioperative complication rate. Redo-MITS did not differ in perioperative outcome from primary-MITS. Multivariable logistic regression analysis identified redo-Sternotomy (odds ratio [OR] = 9.76; 95% confidence interval [CI] 1.88-63.26), liver cirrhosis (OR = 9.88; 95% CI 2.20-54.20), and body mass index (BMI) (OR = 1.16; 95% CI 1.02-1.35) as independent predictors of 30-day mortality. The Cox model revealed redo-Sternotomy (hazard ratio [HR] = 2.67; 95% CI 1.18-6.03), liver cirrhosis (HR = 3.31; 95% CI 1.45-7.58), and pulmonary hypertension (HR = 2.26; 95% CI 1.04-4.92) as risk factors for poor long-term survival. TV surgery significantly reduces NYHA class.CONCLUSION:
Minimally invasive, isolated TV surgery as reoperation without caval occlusion and on the beating heart can be safe and may improve clinical outcome.
Texto completo:
1
Banco de datos:
MEDLINE
Asunto principal:
Válvula Tricúspide
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Insuficiencia de la Válvula Tricúspide
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Toracotomía
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Esternotomía
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Procedimientos Quirúrgicos Cardíacos
Tipo de estudio:
Etiology_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Límite:
Aged
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Aged80
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Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Thorac Cardiovasc Surg
Año:
2018
Tipo del documento:
Article
País de afiliación:
Alemania