title: Tricuspid Valve Replacement Through Right Thoracotomy has Better Outcomes in Redo Cases.
abstract: BACKGROUND
  The tricuspid valve is usually ignored and tricuspid interventions are mostly done in the context of other planned cardiac surgery. Isolated tricuspid reoperative procedure, especially tricuspid valve replacement (TVR) is very rare and carries a very high mortality rate. In this prospective study, clinical results of isolated TVR either through a median re-sternotomy or an antero-lateral thoracotomy with conventional cardiopulmonary bypass (CPB) have been evaluated.
  
  
  METHODS
  Thirty patients with previous open heart surgery through median sternotomy had isolated TVR between 2004 and 2011. Operative approaches were through a median re-sternotomy in 13 patients and a right antero-lateral thoracotomy in 17 patients.
  
  
  RESULTS
  Follow-up period is complete with a mean duration of 19.77±17.08 months. The hospital mortality rates were 46.2% (six patients) in the Median Re-sternotomy Group and 5.9% (one patient) in the Thoracotomy Group (p= 0.025). The surgical procedures lasted shorter and the postoperative drainage amounts were lower in the Thoracotomy Group (298.08±76.64min vs 246.76±47.40min, p= 0.032 and 1787.50±1399.53mL vs 903.33±692.43mL, p= 0.03 respectively). Presence of ascites in the preoperative period (p= 0.007), operative technique (median re-sternotomy) (p= 0.025), use of cross-clamp (p= 0.048), and need for inotropic support during the operation (p= 0.002) were statistically significant factors affecting the hospital mortality. The mean estimated life period was better for the Thoracotomy Group (16.7±5.03 versus 35.9±5.01 months, p= 0.044). Presence of ascites in the preoperative period was a significant risk factor for overall mortality according to Cox regression analysis.
  
  
  CONCLUSIONS
  Thoracotomy for TVR in patients with previous median sternotomy is a practical and safe technique with lower mortality rates.
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey. Electronic address: ohanedan@hotmail.com.
authors.forename: Muhammet Onur
authors.initials: MO
authors.lastname: Hanedan
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Ferit
authors.initials: F
authors.lastname: Çiçekçioğlu
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Ayşen
authors.initials: A
authors.lastname: Aksöyek
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Adem İlkay
authors.initials: Aİ
authors.lastname: Diken
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Ertekin Utku
authors.initials: EU
authors.lastname: Ünal
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Ali İhsan
authors.initials: Aİ
authors.lastname: Parlar
authors.affiliation: Türkiye Yüksek İhtisas Education and Research Hospital, Cardiovascular Surgery, Ankara, Turkey.
authors.forename: Salih Fehmi
authors.initials: SF
authors.lastname: Katırcıoğlu
mesh_terms: D000328:Adult; D000368:Aged; D002315:Cardiopulmonary Bypass; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality*; D011446:Prospective Studies; D056346:Sternotomy; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery*
keywords: Thoracotomy; Tricuspid valve; Tricuspid valve replacement