Uni-Port Total Thoracoscopic Surgery Versus Median Sternotomy for Redo Tricuspid Valve Replacement: A Retrospective Study


  • Licheng Yan Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, P.R. China
  • Fuzhen Zheng Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, P.R. China
  • Haiyu Chen, MD Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, P.R. China
  • Jiayin Bao Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, P.R. China
  • Guoxing Weng, MD Department of Cardiovascular Surgery, Fujian Provincial Hospital, Fuzhou, Fujian, P.R. China




tricuspid valve insufficiency; thoracoscopes; reoperation; sternotomy; retrospective studies


Background: This study compared the perioperative and follow-up period data of patients who underwent redo tricuspid valve replacements performed via thoracoscopic surgery or median sternotomy. The purpose was to evaluate the feasibility, safety, and surgical outcomes of redo tricuspid valve replacement via uni-port thoracoscopic surgery.

Methods: Forty-nine patients with severe tricuspid valve regurgitation after left-side valve replacement underwent redo tricuspid valve replacements in our hospital from April 2012 to September 2019. Twenty-six patients underwent uni-port total thoracoscopy surgery, whereas 23 patients had the surgery performed via median sternotomy. We collected perioperative and 3- to 36-month postoperative data.

Results: No deaths occurred in the intraoperative period. Time of cardiopulmonary bypass in the study group significantly was longer than that in the control group (P < .05), but the operative times in the study and control groups were not significantly different. Thoracic drainage, length of ICU stay, postoperative hospital stay, and complication rates in the study group were significantly different from those in the control group (P < .05). Throughout the follow-up period, uni-port total thoracoscopic TVR was not inferior to traditional surgery with respect to cardiac function and recurrence of tricuspid valve regurgitation.

Conclusions: Uni-port total thoracoscopic tricuspid valve replacement is safe,  feasible and effective, and that can be considered as a primary treatment strategy for patients with severe TR after previous left-sided valve procedure.


Anyanwu AC, Adams DH. 2010. Functional tricuspid regurgitation in mitral valve disease: epidemiology and prognostic implications. Semin Thorac Cardiovasc Surg 22(1):69-75.

Bellavia D, Pentiricci S, Senni M, Gavazzi A. 2014. Update on tricuspid regurgitation. G Ital Cardiol (Rome). 15(7-8):418-429.

Benedetto U, Melina G, Angeloni E, et al. 2012. Prophylactic tricuspid annuloplasty in patients with dilated tricuspid annulus undergoing mitral valve surgery. J Thorac Cardiovasc Surg 143(3):632-638.15.

Bevan PJW, Haydock DA, Kang N. 2014. Long-term survival after isolated tricuspid valve replacement. Heart Lung Circ 23(8):697-702.

Chang HW, Jeong DS, Cho YH, et al. 2017. Tricuspid Valve Replacement vs. Repair in Severe Tricuspid Regurgitation. Circ J. 81(3):330-338.

Chikwe J, Itagaki S, Anyanwu A, Adams DH. 2015. Impact of Concomitant Tricuspid Annuloplasty on Tricuspid Regurgitation, Right Ventricular Function, and Pulmonary Artery Hypertension After Repair of Mitral Valve Prolapse. J Am Coll Cardiol 65(18):1931-1938.

Dreyfus GD, Corbi PJ, Chan KMJ, Bahrami T. 2005. Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair? Ann Thorac Surg. 79(1):127-132.

El-Eshmawi A, Pandis D, Adams DH, Tang GH. 2018. Tricuspid valve surgery: repair and replacement. Minerva Cardioangiol. 66(6):700-712.

Emilsson K, Egerlid R, Nygren B. 2005. Tricuspid annulus motion and mitral annulus motion: Anatomical intimacy causing a good correlation? Exp Clin Cardiol 10(2):111-115.

Gosev I, Yammine M, McGurk S, et al. 2016. Should Moderate-to-Severe Tricuspid Regurgitation be Repaired During Reoperative Left-Sided Valve Procedures? Semin Thorac Cardiovasc Surg 28(1):38-45.

Guenther T, Noebauer C, Mazzitelli D, Busch R, Tassani-Prell P, Lange R. 2008. Tricuspid valve surgery: a thirty-year assessment of early and late outcome. Eur J Cardiothorac Surg 34(2):402-409.

He J, Shen Z, Yu Y, et al. 2012. Criteria for determining the need for surgical treatment of tricuspid regurgitation during mitral valve replacement. J Cardiothorac Surg 7:27-27.

Hwang HY, Kim K-H, Kim K-B, Ahn H. 2014. Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement. Eur J Cardiothorac Surg 46(2):e21-e27.

Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A. 2007. What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg 32(2):296-300.

Jamieson WR, Edwards FH, Schwartz M, Bero JW, Clark RE, Grover FL. 1999. Risk stratification for cardiac valve replacement. National Cardiac Surgery Database. Database Committee of The Society of Thoracic Surgeons. Ann Thorac Surg 67(4):943-951.

Lange R, Piazza N, Günther T. 2017. Tricuspid valve regurgitation : Indications and operative techniques. Herz. 42(7):653-661.

Maleszka A, Kleikamp G, Koerfer R. 2004. Tricuspid valve replacement: clinical long-term results for acquired isolated tricuspid valve regurgitation. J Heart Valve Dis. 13(6):957-961.

Mangoni AA, DiSalvo TG, Vlahakes GJ, Polanczyk CA, Fifer MA. 2001. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg. 19(1):68-73.

Marquis-Gravel G, Bouchard D, Perrault LP, et al. 2012. Retrospective cohort analysis of 926 tricuspid valve surgeries: clinical and hemodynamic outcomes with propensity score analysis. Am Heart J. 163(5):851-858.e851.

McCarthy PM, Bhudia SK, Rajeswaran J, et al. 2004. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg 127(3):674-685.

Moraca RJ, Moon MR, Lawton JS, et al. 2009. Outcomes of tricuspid valve repair and replacement: a propensity analysis. Ann Thorac Surg 87(1):83-89.

Nishimura RA, Otto CM, Bonow RO, et al. 2014. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 63(22):e57-e185.

Pfannmüller B, Moz M, Misfeld M, et al. 2013. Isolated tricuspid valve surgery in patients with previous cardiac surgery. J Thorac Cardiovasc Surg 146(4):841-847.

Pinney SP. 2012. The role of tricuspid valve repair and replacement in right heart failure. Curr Opin Cardiol 27(3):288-295.

Pozzoli A, Lapenna E, Vicentini L, Alfieri O, De Bonis M. 2016. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes. Gen Thorac Cardiovasc Surg. 64(9):509-516.

Raikhelkar J, Lin H-M, Neckman D, Afonso A, Scurlock C. 2013. Isolated tricuspid valve surgery: predictors of adverse outcome and survival. Heart Lung Circ 22(3):211-220.

Singh SK, Tang GHL, Maganti MD, et al. 2006. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg 82(5):1735-1741.

Tokunaga S, Masuda M, Shiose A, Tomita Y, Morita S, Tominaga R. 2008. Long-term results of isolated tricuspid valve replacement. Asian Cardiovasc Thorac Ann. 16(1):25-28.

Tornos Mas P, Rodríguez-Palomares JF, Antunes MJ. 2015. Secondary tricuspid valve regurgitation: a forgotten entity. Heart. 101(22):1840-1848.

Van de Veire NR, Braun J, Delgado V, et al. 2011. Tricuspid annuloplasty prevents right ventricular dilatation and progression of tricuspid regurgitation in patients with tricuspid annular dilatation undergoing mitral valve repair. J Thorac Cardiovasc Surg 141(6):1431-1439.



How to Cite

Yan, L., Zheng, F., Chen, H., Bao, J., & Weng, G. (2020). Uni-Port Total Thoracoscopic Surgery Versus Median Sternotomy for Redo Tricuspid Valve Replacement: A Retrospective Study. The Heart Surgery Forum, 23(3), E350-E357. https://doi.org/10.1532/hsf.2967