Functional tricuspid regurgitation: indications, techniques, and outcomes

Abstract

Functional tricuspid regurgitation (TR) results from asymmetric dilation of the tricuspid valve annulus. This often occurs due to right ventricular enlargement and dysfunction as a consequence of myocardial or valvular abnormalities of the left heart. Even mild TR at the time of left-sided valvular surgery may worsen postoperatively, which carries poor prognostic implications. In spite of data revealing poor outcomes associated with residual TR, surgery for functional TR remains underutilized. Surgical repair techniques for TR include placement of a rigid or semi-rigid tricuspid annular ring, which has been shown to provide superior longevity compared with suture and flexible band repair techniques. Additionally, emerging percutaneous annuloplasty techniques to correct functional TR can expand interventional treatment options to patients who would otherwise carry prohibitive operative risk.

Assessing the correlation between the degree of tricuspid regurgitation and pulmonary hypertension

“…As the severity of TR increases, morbidity and mortality increase and survival declines remarkably. 18 , 19 Consequently, elevated RV systolic pressure and RV dilation and dysfunction are associated with increased TR severity, as reported previously. 18 , 20 On the contrary, RV could adapt its function normally even with the progression of PAH.…”

Does asymptomatic atrial fibrillation exist?

“…There appears to be an association with chronic AF and right atrial enlargement and remodeling resulting in functional TR 49 . Chronic AF can also lead to left ventricular dysfunction, pulmonary hypertension, RV strain and dilatation, and tricuspid annular dilatation 50 . Functional TR secondary to chronic AF has associated risk factors including advanced age, female sex, systemic hypertension, and a lack of pulmonary hypertension 51–54 .…”

“…49 Chronic AF can also lead to left ventricular dysfunction, pulmonary hypertension, RV strain and dilatation, and tricuspid annular dilatation. 50 Functional TR secondary to chronic AF has associated risk factors including advanced age, female sex, systemic hypertension, and a lack of pulmonary hypertension. [51][52][53][54] TR can lead to signs and symptoms of right HF and it is associated with increased mortality independent of LV systolic function, RV size, and RV systolic function.…”

Tricuspid valve repair during mitral valve operations: Put a ring on it!

“…If patients with TR are intervened upon at the time of mitral valve surgery—before they develop severe TR and/or undergo surgery for isolated tricuspid disease—they can have equivalent survival to those who underwent isolated mitral valve repair and normal life expectancy may be restored. 24 , 25 Patients with moderate or worse TR undergoing mitral valve surgery clearly have a survival benefit from concomitant tricuspid repair.…”