Initial experience of minimally invasive triple valve surgery in a developing country

Table 1 Preoperative characteristics and operative data of patients undergoing triple valve surgery

Characteristic	Patient 1	Patient 2	Patient 3	Patient 4
Age (years)	35	41	16	40
Sex	Male	Male	Male	Male
NYHA class	II	II	III	III
LVEF (%)	42.9	47	50	61
Pathology (AS/AR/MS/MR/TR)	MS, MR, AS, AR, TR	MS, MR, AS, AR, TR	MR, MS, AR, AS, TR	MS, MR, AS, AR
ACC time (minute)	195	114	117	170
CPB time (minute)	320	200	270	240
MVR valve (type/size mm)	ATS, 28	SJM, 29	SJM, 27	SJM, 29
AVR valve (type/size mm)	ATS, 20	SJM, 21	SJM19	SJM, 21
TVr technique	Pericardial strip	Pericardial strip	Pericardial strip	Pericardial strip
Association procedure	LAA plication and LA thrombus removal	No	LAA plication	No

NYHA: New York Heart Association; LVEF: Left ventricular ejection fraction; AS: Aortic stenosis; AR: Aortic regurgitation; MS: Mitral stenosis; MR: Mitral regurgitation; TR: Tricuspid regurgitation; ACC: Aortic cross-clamp; CPB: Cardiopulmonary bypass; MVR: Mitral valve replacement; AVR: Aortic valve replacement; TVr: Tricuspid valve repair; ATS: ATS medical mechanical valve; SJM: St. Jude medical mechanical valve; LAA: Left atrial appendage; LA: Left atrium.

Table 2 Postoperative outcomes of patients undergoing triple valve surgery

Outcome	Patient 1	Patient 2	Patient 3	Patient 4
Ventilation time (hour)	12	4	3	4
ICU stay (hour)	47	25	22	23
Hospital stays (days)	8	4	5	5
Postoperative complication	None	Postoperative atrial fibrillation	Pericardial effusion (mild-moderate)	None
Transfusion (units)	Intraoperative: 2 whole blood, 3 platelets, 3 FFP	Intraoperative: 1 PRBC, 1 FFP	Intraoperative: 1 PRBC, 1 FFP	Intraoperative: 2 PRBC
	Postoperative: 1 PRBC, 1 whole blood		Postoperative: 1 PRBC
30-day mortality	None	None	None	None

PRBC: Packed red blood cells; ICU: Intensive care unit; FFP: Fresh frozen plasma.

Table 3 Comparison of minimally invasive multi-valve surgery outcomes

Ref.	Number of patients	Age (year), mean ± SD	Procedure type	Cross-clamp time (minute)	CPB time (minute)	ICU stay (days)	Hospital Stay (days)	30-Day Mortality	Major complications1
Lio et al[13]	12	66 ± 12	AVR + MVR + TVr	95 ± 32	135 ± 41	NR	NR	0%	Stroke 29%, PPM 4.3%
Elmahdy et al[17]	6	76.7 ± 5.4	AVR + MVR + TVr	136 (IQR 119-188)	185 (IQR 145-231)	2.58 (62 hours)	12 (IQR 7-23)	33% (2 patients)	Post-op AF 2 patients
Moront et al[18]	18	Not reported	AVR + MVR + TVr	NR	NR	1.22 (IQR 1.16-1.31)	9 (IQR 6-17)	0%	Neurologic 2, AKI 2, PPM 5
Current our Series	4	33	MVR + AVR + TVr	149	257.5	1.25	5.5	0%	Post-op AF one patients

¹Major complications include re-exploration for bleeding, stroke, acute kidney injury, postoperative atrial fibrillation, or permanent pacemaker implantation.

CPB: Cardiopulmonary bypass; ICU: Intensive care unit; AVR: Aortic valve replacement; MVR: Mitral valve replacement; TVr: Tricuspid valve repair; IQR: Interquartile range; NR: Not reported; AF: Atrial fibrillation; AKI: Acute kidney injury; PPM: Permanent pacemaker.