Introduction
Tricuspid regurgitation (TR) has become a substantial problem because of
its high prevalence and poor clinical outcomes. A conservative estimate
of total burden of moderate or severe TR in the US is 2.4 million
residents both diagnosed and undiagnosed [1]. A large-scale
investigation study in China indicated that the rates of moderate and
severe TR was 2.22% and 1.39%, respectively [2]. Long-term,
higher-grade TR was an independent risk factor and associated with worse
survival [3-5].
Clinical guidelines have adopted broader indications: surgery for
mild-to-moderate TR with tricuspid annulus dilatation or right-heart
failure undergoing left-sided valve surgery and primary symptomatic
severe TR [6, 7]. Nevertheless, surgical correction and its optimal
timing for isolated TR after left-sided valve surgery (LSVS) remains
unclear.
Right mini-thoracotomy approach, beating-heart surgery, single venous
drainage technique and other simplified surgical procedures have been
recently applied in redo isolated tricuspid valve surgery (RITS), and
outcomes of these evolving surgical strategies were encouraging
[8-10]. The first totally endoscopic RITS after LSVS at our
institution dated back to 2013; surgical techniques were later upgraded
in 2015 [11-13], and postoperative and early outcomes were
encouraging.
The present study aimed to review evolving strategies for RITS after
LSVS at our institute in recent years, summarizing mid-to-long term
outcomes and comparing the totally endoscopic approach with traditional
median sternotomy approach.