The following is a summary of “Safety and efficacy of total thoracoscopic surgery for patients with tricuspid regurgitation and reduced right ventricular function after left heart valves replacement: a retrospective comparative study,” published in the August 2023 issue of Cardiology by Lin et al.
In the retrospective study, researchers aimed to compare outcomes of tricuspid valve replacement in patients with reduced right ventricular function after prior left heart valve replacement, assessing mini-thoracotomy versus full-sternotomy approaches.
The study enrolled 44 patients with a problem with their tricuspid valve and weakened right ventricular function after replacing the left heart valves. These patients had gone through surgery to replace their tricuspid valve using thoracoscopic tricuspid valve replacement (T-TVR) or conventional tricuspid valve replacement (C-TVR) from December 2014 to May 2021. After the surgery, the patient’s health, the hospital duration, and how their right ventricle worked were analyzed and reviewed.
The initial characteristics of the T-TVR (n = 25) and C-TVR (n = 19) groups were similar. Both groups had liver dysfunction and renal insufficiency. Also, the hospital mortality wasn’t significantly different between the two groups (8.0% vs. 21.1%, P = .211). However, patients who had T-TVR had less fluid drainage from their bodies (201.60 ± 77.05 ml vs. 614.74 ± 182.31 ml, p < .001), needed fewer blood transfusions after surgery, and duration of hospital stay (15(15–16) vs. 16(14–17) days, P = .019) is less than the C-TVR group. For the first three months after surgery, the T-TVR group showed better and quicker recovery of tricuspid annular plane systolic excursion (TAPSE) and right ventricle fractional area change (RVFAC) (adjusted β = 0.154, 95% CI: 0.037 to 0.271, p = .010 and adjusted β = 0.003, 95% CI: 0.000 to 0.005, p = .024; respectively) as compared to C-TVR.
The study indicated that T-TVR emerged as a promising alternative with comparable mortality, shorter hospital stays, fewer transfusions, and better early recovery of RV function, warranting further validation through future prospective, longer-term randomized trials.