MINIMALLY INVASIVE ISOLATED TRICUSPID VALVE SURGERY: LATE OUTCOME FROM A MULTICENTER STUDY

Background and Aim: To compare the long-term mortality and postoperative adverse events of minimally- invasive isolated tricuspid valve surgery (ITVS) to median sternotomy in an all comers registry. Methods: This retrospective observational study was conducted in the international multicenter SUR-TRI registry, which included patients who underwent isolated TV surgery in 15 different European centers. Results: This study included 476 patients (median age 58.1 years; 44.7% male) who underwent isolated TV surgery either using the minimally invasive approach (MICS; n=72) or median sternotomy (STERNO; n=404). While the reported cardiopulmonary bypass time was significantly longer in MICS (112 vs. 80 minutes; p<0.001), MICS patients less frequently required postoperative blood transfusions (31% vs. 51%; p=0.002), required significantly shorter intensive care (2 vs. 3 days; p<0.001) and had a shorter in-hospital stay (10 vs. 13 days; p=0.054). After surgery, patients were followed for a median of 46.4 (IQR: 9.3-91.4) months, during which 112 patients died (50 cardiac, 62 non-cardiac). Even after adjusting for baseline comorbidities (i.e. EuroSCORE II) and repair/replacement, the minimally invasive approach significantly reduced the risk of all-cause mortality (adjusted HR: 0.430 [95%CI: 0.228-0.819]; p=0.009). This benefit was primarily the result of a reduction in noncardiac mortality (adjusted HR: 0.194; p=0.006). Conclusion: Minimally invasive isolated tricuspid valve surgery may not only improve long- term survival, but also reduce postoperative complications and intensive care stay when compared to median sternotomy in suitable patients. Early timing associated with MICS, beating heart and repair strategy may significantly improve outcome of an upcoming procedure historically considered prohibitive.