JTCVS Open (Dec 2024)

Is concomitant tricuspid valve repair in patients undergoing robotic mitral valve repair safe and effective?Central MessagePerspective

  • Phillip G. Rowse, MD,
  • Yazan AlJamal, MBBS,
  • Richard C. Daly, MD,
  • Austin Todd, MS,
  • Arman Arghami, MD, MPH,
  • Juan A. Crestanello, MD,
  • Joseph A. Dearani, MD

Journal volume & issue
Vol. 22
pp. 214 – 221

Abstract

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Objectives: Robotic-assisted mitral valve repair (MVr) is a well-established procedure for management of degenerative mitral valve disease. Limited data regarding concomitant robotic-assisted tricuspid valve repair (TVr) is available. This review investigates prevalence and outcomes of concomitant robotic-assisted mitral and tricuspid valve repair. Methods: From 2014 to 2022, 839 patients underwent robotic-assisted MVr, including 76 patients with moderate or greater tricuspid regurgitation and/or tricuspid annular dilatation ≥40 mm. Among the 76 patients, 19 (25%) underwent isolated MVr and 57 (75%) had concomitant mitral and tricuspid valve repair. Outcome data between the 2 groups were analyzed. Results: In the MVr/TVr group, tricuspid regurgitation grades were mild in 4 (7%) patients, moderate in 44 (77%) and severe in 9 (15.7%). Significant tricuspid annular dilatation ≥40 mm was present in all patients. In the isolated MVr group, 3 (15.7%) patients had mild tricuspid regurgitation and 16 (84.2%) had moderate tricuspid regurgitation with significant tricuspid annular dilatation present in only 6 patients. Cardiopulmonary bypass and crossclamp time were 130.6 and 91 minutes versus 85 and 55.4 minutes for robotic MVr/TVr group versus MVr group, respectively (P < .05). The intensive care unit and hospital length of stay were similar: 27.7 versus 27.7 hours and 4.4 versus 4.2 days for MVr/TVr versus MVr (P = .24), respectively. There were no perioperative deaths or heart block in either group. Survival and freedom from reoperation with median follow-up of 16 and 46 months for MVr/TVr and MVr groups, respectively were 100%. Conclusions: Concomitant robotic-assisted tricuspid valve repair for functional regurgitation can be safely and effectively performed at the time of mitral valve repair with excellent short-term morbidity and mortality results.

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