Endoscopic Port Access Surgery for Late Orthotopic Cardiac Transplantation Atrioventricular Valve Disease.

BACKGROUND: The study aim was to present details of the perioperative and long-term outcomes of redo-endoscopic port access surgery (REPAS) for late atrioventricular valve disease (AVVD) in orthotopic cardiac transplant (OCT) patients.

METHODS: Between February 2004 and October 2015, REPAS was performed for late AVVD in seven consecutive OCT patients (mean age 57.9 ± 17.2 years; EuroSCORE II 21.2 ± 14.7%) at the authors' institution. The mean OCT-REPAS time interval was 7.8 ± 4.6 years (range: 1.3-13.8 years). NYHA class III or IV symptoms were present in four patients (57%). The mean left ventricular ejection fraction was 52.9 ± 3.9%, and surgical indications included severe mitral valve (MV) and tricuspid valve (TV) regurgitation in three patients (44%) and six patients (86%), respectively. Etiological factors included endomyocardial biopsy trauma (n = 6; 86%), degenerative disease (n = 2; 29%), and fungal endocarditis (n = 1; 14%).

RESULTS: Procedures performed included MV repair (n = 3; 43%) and TV replacement (n = 3; 43%). There were no sternotomy conversions or revisions for any cause. The mean cardiopulmonary bypass and ischemic times were 178.4 ± 48.6 min and 118.3 ± 39.5 min, respectively. In-hospital morbidities included hospital-acquired pneumonia (n = 2; 29%). There were no wound infections or 30-day mortalities. The mean duration of hospitalization was 18.3 ± 11.0 days. A mean of 29.2 ± 45.6 patient-months (total 204.3 patient-months) was available for long-term clinical and echocardiographic analysis (n = 7; 100% complete). No MV or TV reinterventions were required. NYHA class ≤II was achieved in five patients (71%). No patient presented with residual MV regurgitation greater than grade I.

CONCLUSIONS: REPAS for late AVVD in OCT patients is a safe and durable procedure with favorable technique-related mortality, in-hospital morbidity, and long-term cardiac-specific outcomes at experienced centers. The present technique provided an attractive benchmark against which emerging percutaneous interventions may be measured, and earlier referral of patients should be considered.