Key result
Concomitant tricuspid surgery during minimally invasive mitral surgery yields comparable operative mortality to isolated mitral surgery.
Why the study?
Whether adding concomitant tricuspid valve surgery negatively impacts the operative outcomes of minimally invasive mitral valve surgery required evaluation.
Does the addition of concomitant tricuspid valve surgery negatively impact operative outcomes in patients undergoing minimally invasive mitral valve surgery?
Cohort (n=1,158)
No
Does the addition of concomitant tricuspid valve surgery negatively impact operative outcomes in patients undergoing minimally invasive mitral valve surgery?
Performing concomitant tricuspid valve surgery during minimally invasive mitral valve surgery does not increase operative mortality or length of stay, though it increases operative times and the need for a permanent pacemaker.
Answers are grounded in this paper and cite their sources.
Comparable mortality supports concomitant TVS feasibility in MIMVS despite longer times; leaves open net benefit given higher pacemaker rates.
Objective The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS). Methods Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay. Results A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable. Conclusions Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.
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Kilic et al. (2019) conducted a cohort in Mitral and tricuspid valve disease requiring surgical intervention (n=1,158). Concomitant minimally invasive mitral and tricuspid valve surgery (MIMVS + TVS) vs. Isolated minimally invasive mitral valve surgery (MIMVS) was evaluated on Operative mortality (p=0.73). Concomitant tricuspid valve surgery with minimally invasive mitral valve surgery had comparable operative mortality to isolated mitral surgery (4% vs 3%, P=0.73), despite higher pacemaker rates.
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