title: Isolated reoperative minimally invasive tricuspid valve operations.
abstract: BACKGROUND
  Tricuspid valve (TV) regurgitation has recently been identified as a major risk factor for long-term mortality. Isolated reoperative tricuspid valve repair/replacement (TVR/r) carries an excessively high operative risk. Currently, isolated TVR/r with minimally invasive access through a right lateral thoracotomy is being used increasingly in our institution to treat progressive TV pathologic processes after previous cardiac operations. We analyzed our early and midterm results with reoperative TVR/r in this unique patient cohort.
  
  
  METHODS
  Forty-eight consecutive patients underwent isolated TV operations after previous cardiac operations with minimally invasive access through a right lateral thoracotomy at our institution between September 2000 and December 2011. Previous cardiac operations included 26 patients (54.2%) with mitral valve replacement/repair, 18 patients (37.5%) with an aortic valve replacement, 10 patients (20.4%) with a TVR/r, and 8 patients (16.7%) with coronary artery bypass grafting. Operations were performed electively in 79% of patients (n=38). Mean patient age was 63.8±13.4 years, with an average log EuroSCORE of 13.9%±11.3%; 67% of patients were women. Follow-up was 94% complete, with a mean duration of 2.8±2.3 years.
  
  
  RESULTS
  Thirty-day mortality for patients undergoing elective surgery was zero. For all patients early mortality was 4.2%. Five-year survival for patients after elective reoperative TVR/r through minimally invasive access was 72.2%±10.0%, and 5-year freedom from TV-related reoperations was 88.1%±6.7%, respectively.
  
  
  CONCLUSIONS
  Minimally invasive access through a right thoracotomy provides a safe option for reoperative TVR and offers excellent early outcome, particularly in elective cases. Surgical intervention should be performed earlier rather than later.
authors.affiliation: Department of Cardiac Surgery, Heart Centre, University of Leipzig, Germany. pfab@med.uni-leipzig.de
authors.forename: Bettina
authors.initials: B
authors.lastname: Pfannmüller
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Michael A
authors.initials: MA
authors.lastname: Borger
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.forename: Anne-Kathrin
authors.initials: AK
authors.lastname: Funkat
authors.forename: Jens
authors.initials: J
authors.lastname: Garbade
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D012086:Reoperation / Q000379:methods* / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D055815:Young Adult