Objectives:

Concomitant tricuspid valve repair (TVR) or replacement (TVRep) in patients undergoing left-sided valve surgery is recommended in current guidelines. Fully endoscopic combined valve surgery has been well-established at our center. This study was conducted as a retrospective data analysis to characterize procedural and outcome parameters of patients undergoing endoscopic concomitant TVR/TVRep.

Methods:

From 2015 and 2021, 674 consecutive patients underwent endoscopic surgery. All consecutive patients who underwent concomitant endoscopic TVR/TVRep were identified and included for analysis. Baseline, procedural and acute hemodynamic and clinical outcome parameters were assessed.

Results:

Concomitant tricuspid valve surgery was performed in 45 patients (66.1 ± 9.4 years, female gender 64.4%, LVEF 57 ± 11.1%, TAPSE 22.5 ± 6.6 mm, pulmonary hypertension > 60 mmHg 6.7%). Indications for TVR/TVRep were mild / moderate / severe tricuspid regurgitation (TR) in 6 (13.3%) / 19 (42.2%) / 18 (40%) cases. TR was of secondary etiology in the majority of cases. In most cases TVR/TVRep was performed as beating-heart procedure (31/45, 68.9%), noting a significant increase in these procedures over the study period (p=0.003).

The majority of patients (43/45, 95.6%) received TVR by isolated annuloplasty (Edwards Cosgrove band 37/43, 86%, band size 31.4 ± 1.2 mm; Medtronic 3D Contour 6/43, 14%, ring size 29.7 ± 1.5 mm), the remaining patients received TVRep (2/45, 4.4%). Concomitant ablation and/or left atrial appendage closure were performed in 53.4% (24/45) of cases.

After TVR/TVRep, no / mild / moderate residual TR was documented in 64.4%, 31.1% and 2.2% of patients, respectively. Procedure time was 246.6 ± 42.2 minutes. Post cardiotomy low-cardiac output syndrome was observed in 6.7% (3/45) and was conservatively managed in all cases. Stroke and 30-day mortality rates were 1.1% (1/45) and 0%, respectively. Acute outcome parameters were similar in beating- vs. arrested-heart TVR/TVRep cases (p=0.51).

Conclusion:

Concomitant endoscopic TVR/TVRep is feasible and safe with excellent acute outcome regarding correction of TR. In this analysis, beating-heart TVR/TVRep seems non-inferior to an arrested-heart approach, but further data is needed.