Minimally-invasive tricuspid valve operations: three decades of Leipzig experience

OBJECTIVES: Data on minimally invasive tricuspid valve surgery for severe tricuspid regurgitation remain limited, particularly regarding long-term outcomes. METHODS: This retrospective single-center study included adult patients who underwent minimally invasive tricuspid valve surgery through right mini-thoracotomy for severe tricuspid regurgitation as the primary indication between 1996 and 2024. Patients with endocarditis or tricuspid stenosis, as well as those undergoing left-sided valve surgery, were excluded. The primary endpoint was all-cause mortality during follow-up. RESULTS: A total of 199 patients with a median age of 70.0 years, including 110 (55%) women, were analyzed. Sixty-four (32%) had previous cardiac surgery. Median EuroSCORE II was 3.6% (1.8-6.0) and median TRI-SCORE-predicted mortality was 5.0% (3.0-14.0). Three patients (1.5%) required conversion to sternotomy. Tricuspid valve repair was performed in 108 patients (54%). In-hospital mortality was 6% for the entire cohort (12/199). Discharge echocardiography demonstrated no or mild residual tricuspid regurgitation in 176/194 patients (91%). Estimated overall survival was 85% (95% confidence interval, 80-90%) at 1 year, 69% (62-75%) at 5 years, and 53% (46-61%) at 10 years. Repeat tricuspid valve surgery was recorded in 7 patients (4%). In multivariable analysis, older age, male sex, urgent/emergent operation, atrial fibrillation/flutter, diabetes mellitus, signs of right heart failure, lower glomerular filtration rate and lower preoperative hemoglobin independently predicted mortality. CONCLUSIONS: Minimally invasive tricuspid valve surgery for severe tricuspid regurgitation was associated with low conversion rates and provided good early and late outcomes. Repair was performed in over half of patients.