Evidence-based surgical management of acquired tricuspid valve disease

Abstract

Tricuspid valve (TV) disease most often occurs secondary to left-sided heart disease, particularly mitral valve (MV) regurgitation or stenosis. Appropriate treatment, even when TV regurgitation is secondary to left-sided heart disease, can improve long-term outcome. Valvuloplasty is the most common procedure for TV disease, and has received an increasing amount of attention, as right-sided heart failure combined with TV regurgitation is associated with poor long-term outcome. Although some controversies exist regarding the indication and timing of the TV operation, concomitant surgical repair of TV regurgitation at the time of MV surgery should be considered, as this procedure improves perioperative outcomes, functional class, and survival. Importantly, TV repair does not increase operative mortality. In our experience, both suture annuloplasty and partial ring annuloplasty give satisfactory results, and bioprosthetic valves can be used when leaflets are damaged and the TV annulus is extremely dilated.

Leaflet Area as a Determinant of Tricuspid Regurgitation Severity in Patients With Pulmonary Hypertension

“…This hypothesis, if correct, would provide the justification and context to investigate the mechanisms of leaflet adaptation 8 and the use of leaflet augmentation as a therapeutic procedure for functional TR, which is currently a topic of ongoing debate 9 . Although not yet proven, patients with inadequate leaflet adaptation would be expected to benefit more from leaflet augmentation.…”

Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach

“…On the basis of this conclusion, we adopted a conservative approach to the tricuspid valve during pulmonary valve replacement. Since that time, there seems to be recent emphasis on a more aggressive approach to the tricuspid valve, not only in congenital heart disease but also in acquired left-sided heart disease [4][5][6][7][8]. We thought it would be prudent to reconsider our position and reevaluate these same patients through midterm follow-up.…”

Surgical management of tricuspid stenosis

“…Broadly speaking, biological prostheses for TVR are preferred over mechanical ones because of the higher risk of thrombosis carried by the mechanical valve (9). A patient with a mechanical valve in the tricuspid position must be closely managed with an international normalized ratio (INR) between 2.5 to 3.5.…”