Totally Endoscopic, Robotic-Assisted Tricuspid Valve Repair and Biatrial Cryo-MAZE

MO004 

Case Video Submission 

Andrea Amabile (1), Michael LaLonde (2), Irbaz Hameed (3), Syed Usman Bin Mahmood (4), Wei-Guo Ma (5), Arnar Geirsson (6), Markus Krane (7)

(1) Yale School of Medicine, New Haven, CT, (2) Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, (3) Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, (4) N/A, N/A, (5) Beijing Anzhen Hospital, CHESHIRE, Connecticut, (6) Yale New Haven Hospital, New Haven, CT, (7) Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT

Andrea Amabile    -  Contact Me
Yale School of Medicine

Michael LaLonde    -  Contact Me
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine

Irbaz Hameed    -  Contact Me
Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine

Syed Usman Bin Mahmood    -  Contact Me
N/A

Wei-Guo Ma    -  Contact Me
Beijing Anzhen Hospital

*Arnar Geirsson    -  Contact Me
Yale New Haven Hospital

Markus Krane    -  Contact Me
Division of Cardiac Surgery, Yale School of Medicine

Andrea Amabile    -  Contact Me
Yale School of Medicine

Objective: We present the case of a 66-year-old male with sick sinus syndrome, atrial fibrillation, and a recent history of right ventricular pacemaker lead extraction after which he experienced progressive fatigue and decreased endurance. He was referred to our institution for isolated, iatrogenic, severe tricuspid regurgitation due to torn septal tricuspid leaflet.

Case Video Summary: Ports configuration consisted of the working port being placed in the third intercostal space at the anterior axillary line, the left robotic arm port placed in the second intercostal space, halfway between the anterior axillary line and the midclavicular line, the right robotic arm port placed in the fifth intercostal space, slightly below the anterior axillary line, and the atrial retractor placed in the fourth intercostal space, two centimeters medial to the midclavicular line. Cardiopulmonary bypass was achieved by percutaneous femoral artery cannulation and by percutaneous femoral and internal jugular veins cannulation. Aortic cross-clamp was performed with the Chitwood endothoracic clamp. After snaring of the venae cavae, the left atrium was accessed via the Waterson's groove. We closed the left atrial appendage and we then performed left-sided CryoMAZE (epicardial coronary sinus line, mitral valve line, pulmonary vein line, base of the atrial appendix). After closure of the left atriotomy, a right atriotomy was performed and the tricuspid valve was accessed and inspected, showing torn septal leaflet. The tricuspid valve was repaired by reimplanting the tip of the leaflet to a papillary muscle-like structure on the right ventricular wall, multiple clefts closure (Video), and placement of a 34-mm annuloplasty band. We then performed right-sided CryoMAZE (isthmus line, superior and inferior venae cavae, and right atrial appendage). At the end of the procedure, transesophageal echocardiography revealed trace tricuspid regurgitation and a mean gradient of 1 mmHg. The patient was discharged home on sinus rhythm.

Conclusions: Our case demonstrates the safety and effectiveness of a totally endoscopic, robotic-assisted approach for the treatment of iatrogenic, severe tricuspid regurgitation and atrial fibrillation.

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