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Cardiac surgery: New total endoscopic surgical method for complex re-operations of the tricuspid valve


At the Department of Cardiac Surgery at University Hospital Vienna and MedUni Vienna, an innovative operation on the tricuspid valve, the inlet valve of the right ventricle, was performed for the first time in Austria, in which neither the sternum had to be opened nor the heart stopped. Around thirty years after the first operation, the tricuspid valve was completely replaced in a minimally invasive procedure in a patient who had already undergone cardiac surgery before. The total endoscopic method was further developed within the Christian Doppler Laboratory for Microinvasive Heart Surgery at MedUni Vienna for the re-operation of the tricuspid valve.

The tricuspid valve, one of four heart valves, acts as a valve between the right atrium and the right ventricle. It allows deoxygenated blood to flow from the body into the right ventricle and prevents the blood from flowing back during the pumping process. Due to its complexity, this heart valve is considered particularly difficult to treat and an operation to replace the heart valve in the event of a severe defect carries a higher mortality risk than other heart valve operations. Surgery on the tricuspid valve is even more complex if it has already been operated on in the past, as scarring has often occurred. A team led by Martin Andreas and Iuliana Coti from the Department of Cardiac Surgery at MedUni Vienna and University Hospital Vienna (Head: Daniel Zimpfer) has now succeeded for the first time in Austria in performing a completely endoscopic and therefore particularly gentle heart valve replacement on a patient who had tricuspid valve surgery around 30 years ago, also applying a novel surgical bioprosthesis. The innovative surgical method was developed at the Christian Doppler Laboratory for Microinvasive Heart Surgery at MedUni Vienna together with international experts in the field of total endoscopic surgery.

A special new suture system (RAM Device) developed for total endoscopic surgery was used during the procedure. This special system made it possible to insert the new heart valve through a very small incision without opening the sternum or using a retractor. The heart valve was completely replaced on the beating heart through a small access on the lateral chest wall. This meant that the risk for the patient, who had already undergone tricuspid valve surgery around 30 years ago, was kept particularly low and a new heart valve model (Mitris) was implanted, which was only recently approved in Europe and promises a particularly long service life.

"During the operation, we succeeded in expanding the use of a particularly gentle method established in cardiac surgery for tricuspid valve procedures. This means that patients who have already undergone surgery in the past now have a minimally invasive, completely endoscopic treatment option for a complex procedure," says Martin Andreas from the Department of Cardiac Surgery and Head of the CD Laboratory for Microinvasive Heart Surgery, who performed the operation together with Iuliana Coti. In recent years, the heart valve team at University Hospital Vienna and MedUni Vienna has intensively studied the risks of isolated tricuspid valve surgery and published several papers on the subject, with the aim of solving unanswered clinical questions for patients with heart disease in Austria and worldwide.

The patient was able to leave the hospital in very good condition just one week after the procedure. The successful application of the new surgical method marks a milestone in cardiac surgery and offers promising prospects for patients who require complex reoperations on the heart.


Mag. Johannes Angerer
Medizinische Universität Wien
Leiter Kommunikation und 
Tel.: 01/ 40 160 11 501
Spitalgasse 23, 1090 Wien

Karin Fehringer, MBA
Leiterin Informationszentrum und PR
Universitätsklinikum AKH Wien
Wiener Gesundheitsverbund
Tel.: +43 1 404 00-12160
Währinger Gürtel 18-20, 1090 Wien

Mag.a Silvia Samhaber, BA
Universitätsklinikum AKH Wien
Medizinische Universität Wien
Tel.: +43 1 40 160 11 519