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Does Adding A Tricuspid Valve Repair Impact Short And Long Term Outcomes Of Endoscopic Mitral Valve Surgery ?
Mukesh Karuppannan, Abdelbarr Abdelrahman, Palanikumar Saravanan, Andrew Knowles, Argyle Rachel, Grzegorz Laskawski, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.

OBJECTIVE: The objective of this study was to review the impact of concomitant tricuspid valve surgery (TVS) on short and long term outcomes of endoscopic mitral valve surgery (EMVS).
METHODS: Patients who underwent endoscopic minimally invasive mitral valve surgery between 2007 and 2020 at a single institution were reviewed. Patients were primarily grouped by those undergoing isolated EMVS against EMVS+TVS. Short and long term outcomes were analysed from a prospectively collected departmental database.
RESULTS: A total of 329 patients underwent EMVS out of which 52 (15.90%) underwent concomitant TVS. Patients undergoing EMVS + TVS were at higher risk at baseline (LogEUROscore 6.97 vs 3.74 for EMVS group). Cardiopulmonary bypass times (180.1432 vs. 164 42min; p < 0.001) and aortic occlusion times (125.9230 vs. 108.0436 min; p < 0.001) were longer in the EMVS + TVS group. Operative mortality was higher but acceptable and below the predicted mortality (1.92% for EMVS + TVS vs 0.72% isolated EMVS, p = 0.55). Permanent pacemakers were required more frequently in the EMVS + TVS group (0.37% vs 5.36% p <0.03). All other complication rates were similar. Mean length of postoperative hospital stay was 9.34 days for EMVS+TVS while it was 7.19 days for EMVS group. Long term survival at 8 years was comparable (82.70% EMVS+TVS vs 88.09% for EMVS,p = 0.45, HR of 1.052 (95% CI 0.80-1.63)
CONCLUSIONS: Despite longer operative times, EMVS+TVS has similar postoperative outcomes to isolated EMVS.We would recommend addressing the tricuspid valve, if indicated, during an endoscopic mitral valve procedure.

Perioperative variablesEMVS + TVS (n = 52)EMVS(n = 277)p-value
Age range(years)37-88(70.65)20-92(62.11)0.03
Female {n, (%)}35 (67.30%)119 (42.96%)0.02
Logistic Euroscore ,{Mean (Range)}6.97 (1.5-24.04)3.74(1.5-43.23)<0.001
CPB time,mins (mean)180.14 (SD 32)164 (SD 42)<0.001
Aortic occlusion time,mins (mean)125.92 (SD 30)108.04 (SD 36)<0.001
30 day mortality {n, (%)}1 (1.92%)2 (0.72%)0.54
Mean ICU stay(days)1.27 (SD 0.64)1.41 (SD 3.22)0.003
Heart block requiring PPI {n, (%)}3 (5.76%)1 (0.36%)0.03
Prolonged ventilation(>48 hrs) {n, (%)}1 (1.92%)9 (3.24%)0.02



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