Objectives
According to current guidelines, tricuspid valve repair (TVR) is recommended in patients with severe secondary tricuspid regurgitation (TR) undergoing left-sided valve surgery, and should also be considered in those with mild-to-moderate TR and annular dilatation. However, data on patient characteristics and outcomes of concomitant TVR in the setting of endoscopic mitral valve surgery (MVS) remain limited. This study aimed to evaluate the use and outcomes of concomitant TVR in patients undergoing fully endoscopic MVS at a high-volume center.
Methods
Data from 341 consecutive patients who underwent fully endoscopic MVS between 2021 and 2023 were retrospectively analyzed. All procedures were performed via a right anterolateral mini-thoracotomy using soft tissue retraction and 3D endoscopic guidance. Patients were stratified into two groups: concomitant MVS+TVR and isolated MVS. The primary endpoints were in-hospital mortality and major postoperative complications.
Results
Among 341 patients (median age 61 years, 63.2% male), 47 (13.8%) underwent concomitant MVS+TVR. Compared with isolated MVS, these patients were significantly older (66 [IQR 58–73] vs. 60 [53–68] years; p<0.002), had higher surgical risk (STS-PROM score 0.8 [0.4–1.4] vs. 0.4 [0.3–0.7] %; p<0.003), elevated NT-proBNP levels (1384 [682–2320] vs. 317 [139–996] pg/mL; p<0.001), and were more symptomatic (NYHA class ≥III: 55.4% vs. 26.0%; p=0.004). Preoperative TAPSE was within the normal range in both groups but lower in the MVS+TVR cohort (20 [18–26] vs. 25 [21–28] mm; p<0.001). Cross-clamp times were comparable (95 vs. 90 min; p=0.824), while cardiopulmonary bypass duration was longer in the MVS+TVR group (191 [168–224] vs. 147 [127–177] min; p<0.001), partly due to a higher rate of additional atrial ablation (38.3% vs. 22.1%; p=0.018) and left atrial appendage closure (57.4% vs. 24.8%; p<0.001). No significant differences were observed in postoperative right heart failure (6.4% vs. 3.1%; p=0.255) or low-output syndrome (14.9% vs. 7.8%; p=0.115). However, median TAPSE at discharge was significantly lower in the MVS+TVR group (11 [10–13] vs. 15 [13–18] mm; p<0.001). In-hospital mortality was low and comparable between groups (0.0% vs. 0.7%; p=0.571).
Conclusion
Concomitant TVR is frequently performed during fully endoscopic MVS and can be safely implemented despite a higher-risk patient profile. These patients often represent an advanced disease cohort, highlighting the importance of comprehensive preoperative evaluation and individualized surgical planning.
