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Mitral Valve Surgery

Tricuspid valve repair is almost always performed due to tricuspid regurgitation and in conjunction with left-sided valve surgery or coronary artery bypass graft. Sole tricuspid valve repairs are rare, due to an increased incidence of complications[1]. The main indication for tricuspid valve repair is secondary tricuspid regurgitation due to annular enlargement, right ventricular remodeling, and advanced left heart diseases. Structural abnormalities of the valve itself usually require replacement[1]. Following are the indications for tricuspid valve repair or replacement[1][2][3][5]:

  • Tricuspid regurgitation: It is the most common indication requiring tricuspid valve repair. Severe tricuspid regurgitation is associated with a poor prognosis, independent of age, biventricular function, and right ventricular size. Untreated tricuspid regurgitation leads to increased morbidity and mortality[1][3][5].
  • Symptoms: Tricuspid valve repair may be considered for patients with moderate functional TR and pulmonary arterial hypertension at the time of left-sided valve surgery[5].
  • Pulmonary hypertension: Tricuspid valve repair is associated with lower perioperative mortality as compared to valve replacement in patients with functional TR and, therefore, is generally the preferred surgical treatment option. Tricuspid valve replacement should be considered when valve repair is technically not feasible or predictably not durable (e.g., in patients with profound right ventricular remodelling or dysfunction, or higher pulmonary artery pressures) [3].
  • Long-term anticoagulation: Indications for mechanical tricuspid valve replacement include an already established indication for long-term anticoagulation (concomitant mechanical left) [6].

Citations:
[1] https://www.ncbi.nlm.nih.gov/books/NBK559179/
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5808495/
[3] https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-16/Treatment-options-for-severe-functional-tricuspid-regurgitation-indications-techniques-and-current-challenges
[4] https://www.sts.org/sites/default/files/documents/Latin_America_2017/1554%20B_Thurs_Timing%20and%20Indications%20for%20Isolated%20Tricuspid%20Surgery_Pomar.pdf
[5] https://www.jacc.org/doi/10.1016/j.jcmg.2018.11.034
[6] https://www.sciencedirect.com/topics/medicine-and-dentistry/tricuspid-valve-repair