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Isolated Endoscopic Tricuspid Valve Surgery

Tuesday, September 10, 2019

Abdelbar A, Zacharias J. Isolated Endoscopic Tricuspid Valve Surgery. September 2019. doi:10.25373/ctsnet.9770324.

Isolated tricuspid regurgitation has been increasingly diagnosed amongst the population (1). Intracardiac devices and the prevalence of atrial fibrillation (AF) are now the most common causes of AF (2).

Morbidity and mortality from tricuspid regurgitation can be significant (3). However, surgery for isolated tricuspid valve regurgitation is still believed to be under-performed compared to the number of patients diagnosed. This rarity exists despite the clear guidelines to intervene in cases of severe symptomatic tricuspid regurgitation (4). The main reason for this under-performance is the reported high mortality following conventional sternotomy (5). Also, referral for surgery is often delayed until patients develop intractable right-sided heart failure. Recently, a few centers reported endoscopic minimal access tricuspid surgery with better results compared to standard sternotomy (6). In this video, the authors present a single-center experience with this type of surgery and seek to promote more surgical treatment for tricuspid valve pathologies.


  1. Arsalan M, Walther T, Smith RL, Grayburn PA. Tricuspid regurgitation diagnosis and treatment. Eur Heart J.2017; 38:634–638.
  2. Chang JD, Manning WJ, Ebrille E, Zimetbaum PJ. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol. 2017 May 1;69(18):2331-2341.
  3. Fender EA, Zack CJ, Nishimura RA. Isolated tricuspid regurgitation: outcomes and therapeutic interventions. Heart. 2018;104:798–806.
  4. Baumgartner H, Falk V, Bax JJ, De Bonis M, Hamm C, Holm PJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017 Aug 26;38(36):2739-2791.
  5. Rankin JS, Hammill BG, Ferguson TB Jr, Glower DD, O’Brien SM, DeLong ER, et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg. 2006 Mar 1;131(3):547-557.
  6. Lee TC, Desai B, Glower DD. Results of 141 consecutive minimally invasive tricuspid valve operations: an 11-year experience. Ann Thorac Surg. 2009 Dec 1;88(6):1845-1850.

Mr Zacharias is a proctor for Edwards Lifesciences, Abbott, and Cryolife.

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