Comparison of port access to sternotomy in tricuspid or mitral/tricuspid operations.
BACKGROUND
Outcomes for a port-access (PA) approach for tricuspid valve operations have not been reported or compared to those using median sternotomy (MS).


METHODS
Retrospective analysis was performed for 88 consecutive patients undergoing tricuspid valve repair or replacement using port-access techniques (n = 27, 1997-2000) versus sternotomy (n = 61, 1990-1997). PA procedures were performed through a 6 cm right fourth interspace thoracotomy.


RESULTS
PA patients had lower ejection fractions (46% +/- 11% vs. 54% +/- 10%, p = 0.02), but had a similar incidence of previous surgery (17/27 (63%) vs. 33/61 (54%), p = 0.4). PA patients had more frequent concurrent mitral valve operations (22/27 (82%) vs. 37/61 (61%), p <0.05) and more tricuspid repairs versus replacement (24/27 (89%) vs. 29/61 (48%), p <0.01). PA patients had longer pump times (254 min. +/- 82 vs. 162 min. +/- 61, p = 0.001) but comparable clamp times (65 min. +/- 15 vs. 63 min. +/- 41, p = 0.9), lengths of stay (14 days +/- 14 vs. 16 days +/- 16, p = 0.6), mortality (2/27 (7%) vs. 9/61 (15%), p = 0.3), strokes (3/27 (11%) vs. 4/59 (7%), p = 0.9), and need for new pacemaker implantation (5/27 (19%) vs. 12/61 (20%), p = 0.9).


CONCLUSIONS
PA provided excellent short-term results comparable to MS in relatively high-risk tricuspid valve patients. For tricuspid operations, PA may have the advantage of avoiding sternotomy or reoperative sternotomy at the expense of longer pump times.
Duke University Medical Center, Durham, NC 27710, USA.
Henry F
HF
Tripp
Donald D
DD
Glower
James E
JE
Lowe
Walter G
WG
Wolfe
D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*