Robotic Assisted Beating Heart Tricuspid Valve Replacement Post Left Ventricular Assisted Device and Implantable Cardioverter Defibrillator

Tricuspid valve regurgitation in patients with prior HeartMate 3 left ventricular assist device (LVAD) and Implantable Cardioverter Defibrillator present significant surgical challenges due to dense mediastinal adhesions, proximity of the LVAD outflow graft and intracardiac device leads. Robotic assisted tricuspid valve replacement (TVR) approach has been rarely described in literature. The LVAD was maintained at low flow during cardiopulmonary bypass. Vacuum-assisted venous drainage was utilized to augment the venous drainage. Robotic-assisted beating heart TVR offers safer approach in such patients. Robotic approach avoids redo sternotomy, LVAD outflow graft injury and provides excellent exposure, even in the presence of dense adhesions.