title: Combined Mitral and Tricuspid Valve Surgery Performed via a Right Minithoracotomy Approach.
abstract: OBJECTIVE
  Combined mitral and tricuspid valve surgery is associated with an increased perioperative morbidity and mortality. We evaluated the outcomes of a less invasive right minithoracotomy approach in patients undergoing primary or reoperative double-valve surgery.
  
  
  METHODS
  We retrospectively evaluated 132 consecutive patients with mitral and tricuspid valve disease who underwent double-valve surgery via a right minithoracotomy at our institution between January 2009 and April 2014.
  
  
  RESULTS
  The cohort included 81 female (61%) and 51 male (39%) patients, with a mean ± SD age of 67 ± 13 years. The mean ± SD preoperative left ventricular ejection fraction, mitral regurgitation grade, and creatinine were 53% ± 12%, 3.8 ± 0.6, and 1.26 ± 1.17, respectively. The patients underwent primary (88%) or reoperative (12%) mitral and tricuspid valve surgery, which consisted of 88 mitral repairs (67%), 44 mitral replacements (33%), 131 tricuspid repairs (99%), and 1 tricuspid replacement (1%). Postoperatively, there were 6 cases of acute kidney injury (5%), 6 reoperations for bleeding (5%), 4 cerebrovascular accidents (3%), and 12 cases of atrial fibrillation (9%). The median intensive care unit length of stay and total hospital lengths of stay were 61 hours (interquartile range, 43-112 hours) and 8 days (interquartile range, 6-13 days), respectively. The in-hospital mortality was 4%. Actuarial survival at 1 and 5 years was 93% and 88%, respectively.
  
  
  CONCLUSIONS
  In patients undergoing primary or reoperative mitral and tricuspid valve surgery, a right minithoracotomy approach is associated with a low perioperative morbidity and good midterm survival.
authors.affiliation: From the *Columbia University Division of Cardiology at the Mount Sinai Heart Institute, and †Department of Anesthesia at Mount Sinai Medical Center, Miami Beach, FL USA.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Andrés M
authors.initials: AM
authors.lastname: Pineda
authors.forename: Hector
authors.initials: H
authors.lastname: Davila
authors.forename: Maiteder C
authors.initials: MC
authors.lastname: Larrauri-Reyes
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
mesh_terms: D000368:Aged; D005260:Female; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods* / Q000401:mortality; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D013908:Thoracotomy / Q000379:methods* / Q000401:mortality; D014261:Tricuspid Valve / Q000601:surgery*