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Purpose: To compare outcome using port-access (PA) to
median sternotomy (MS) for tricuspid valve operation.
Methods: Retrospective analysis was performed of 100 patients
undergoing tricuspid valve repair or replacement using port-access
techniques (N=27,1997-2000) versus sternotomy (N=73,1990-1997).
PA procedures were performed through a 6 cm right 4th
interspace thoracotomy.
Results: PA patientswere older (63+10 vs 54+21,
p<0.05), had lower ejection fraction (45+11 vs 54+11,
p=0.01), but had similar incidence of previous surgery (13/27(48%)
vs 35/73(48%)). PA had more frequent concurrent mitral operation
(22/27(81%) vs 43/73(59%), p<0.05) and more tricuspid repair
versus replacement (24/27(89%) vs 31/73(42%), p<0.01). PA
had longer pump time (CPB) but comparable clamp time, length of
stay (LOS), mortality, stroke, and need for new pacemaker. (*p<0.05
vs MS)
| |
CPB(min) |
LOS (dy) |
Mortality |
Stroke |
Pacer |
| PA |
252+81* |
16+16 |
2/27(7%) |
3/27(11%) |
3/27(11%) |
| MS |
161+64 |
15+16 |
10/73(14%) |
3/73(4%) |
11/73(15%) |
Conclusions: PA provides excellent short-term results
comparable to MS in relatively high risk tricuspid valve patients.
For tricuspid operations, PA may have advantages of avoiding redosternotomy,
better cosmesis, and fewer wound complications, at the expense
of longer pump times.
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