Concomitant Tricuspid Valve Repair in Patients Undergoing Fully Endoscopic Mitral Valve Surgery: A Real-World Experience

All articles of this category (opens in new window) Background: According to current guidelines, tricuspid valve repair (TVR) is recommended in patients with severe secondary tricuspid regurgitation (TR) undergoing left-sided valve surgery, and should also be considered in those with mild-to-moderate TR and annular dilatation. However, data on patient characteristics and outcomes of concomitant TVR in the setting of endoscopic mitral valve surgery (MVS) remain limited. This study aimed to evaluate the use and outcomes of concomitant TVR in patients undergoing fully endoscopic M vs. at a high-volume centre. Methods: Data from 341 consecutive patients who underwent fully endoscopic M vs. between 2021 and 2023 were retrospectively analyzed. All procedures were performed via a right anterolateral mini-thoracotomy using soft tissue retraction and 3D endoscopic guidance. Patients were stratified into two groups: concomitant M vs. + TVR and isolated MVS. The primary endpoints were in-hospital mortality and major postoperative complications. Results: Among 341 patients (median age 61 years, 63.2% male), 47 (13.8%) underwent concomitant M vs. + TVR. Compared with isolated MVS, these patients were older (66 [IQR: 58–73] vs. 60 [53–68] years; p < 0.002), had higher surgical risk (STS-PROM score 0.8 [0.4–1.4] vs. 0.4 [0.3–0.7] %; p < 0.003), elevated NT-proBNP levels (1,384 [682–2,320] vs. 317 [139–996] pg/mL; p < 0.001), and were more symptomatic (NYHA class ≥ III: 55.4% vs. 26.0%; p = 0.004). Preoperative TAPSE was within the normal range in both groups (20 [18–26] vs. 25 [21–28] mm; p < 0.001). Cross-clamp times were comparable (95 vs. 90 minutes; p = 0.824), while cardiopulmonary bypass duration was longer in the M vs. + TVR group (191 [168–224] vs. 147 [127–177] minutes; p < 0.001), partly due to a higher rate of additional atrial ablation (38.3% vs. 22.1%; p = 0.018) and left atrial appendage closure (57.4% vs. 24.8%; p < 0.001). No significant differences were observed in postoperative right heart failure (6.4% vs. 3.1%; p = 0.255) or low-output syndrome (14.9% vs. 7.8%; p = 0.115). However, median TAPSE at discharge was significantly lower in the M vs. + TVR group (11 [10–13] vs. 15 [13–18] mm; p < 0.001). In-hospital mortality was low in both groups (0.0% vs. 0.7%; p = 0.571). Conclusion: Concomitant TVR is frequently performed during fully endoscopic M vs. and can be safely implemented despite a higher-risk patient profile. These patients often represent an advanced disease cohort, highlighting the importance of comprehensive preoperative evaluation and individualized surgical planning. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany