Total Thoracoscopic Surgery Versus Median Sternotomy For Tricuspid Valve Replacement After A Left-sided Valve Procedure

ObjectiveThis study compared the perioperative and follow-up period data of patients who underwent repeat tricuspid valve replacements performed via thoracoscopy or median sternotomy.The purpose was to evaluate the feasibility,safety,and surgical outcomes of repeat tricuspid valve replacement via thoracoscopy.MethodsForty-one patients with severe tricuspid valve regurgitation after left-side valve replacement underwent repeat tricuspid valve replacements in our hospital from April 2012 to August 2017.Eighteen of these patients underwent total thoracoscopy surgery,whereas 23 patients had the surgery performed via median sternotomy.We collected perioperative and 4-to 36-month postoperative data.ResultsNo deaths occurred in the intraoperative period.In the control group,three patients died during the surgical hospitalization,and one patient died from meningitis during the follow-up period.In the study group,there were no deaths during hospitalization or follow-up.Time of CPB in study group was significantly longer than this in the control group(P<0.05),but the operative times(201.4±63.9min)in the study group and the control group(205.6±89.7min)were not significantly different(P>0.05).Thoracic drainage,length of ICU stay,postoperative hospital stay,and complication rates in the study group were significantly different from those in the control group(P<0.05).However,isolated complication rates and the number of surgery-related deaths were compared,and there were no statistically significant differences between the two groups(P>0.05).Throughout the follow-up period,as a group,the patients' cardiac function and activity endurance improved significantly.In the study group,12 patients were in NYHA class I and 6 patients were in NYHA class II.Recurrent TV regurgitation(++)occurred in four patients and recurrent regurgitation(+++)occurred in two patients.In the control group,10 patients were in NYHA class I,eight patients were in NYHA class II,one patient was in NYHA class III,and recurrent TVR(++)occurred in two patients.There were no statistically significant differences in the surgical outcome between the two groups.patients' quality of life and activity endurance were significantly improved in both groups.Conclusiontotal thoracoscopic TVR is a safe,feasible,and promising approach for the treatment of TR.Furthermore,it has the advantages of better cosmetic effects,decreased bleeding,lower surgical complication rates,rapid postoperative recovery,and improved cardiac function and quality of life.We suggest that total thoracoscopic TVR is the preferred approach for patients with severe TR who previously underwent a left-sided valve procedure.