Cardiothoracic Surgery

Tricuspid Valve Repair/Replacement

Doctor examinging an elderly male patient

What Is A Tricuspid Valve?

The tricuspid valve is the valve that separates the right atrium and ventricle of the heart. This valve serves to allow the downward movement of blood from the atrium to the ventricle without backflow. Because the tricuspid valve controls the movement and flow of blood to areas of the body that require it, it is an extremely important part of the heart and overall health.

What Is Tricuspid Valve Disease?

The tricuspid valve is comprised of three leaflets, flaps of tissue that control the flow of blood. When a tricuspid valve is faulty, one of two things may happen.

Tricuspid stenosis is when the leaflets of the tricuspid valve are too stiff, preventing the forward flow of blood. This makes it harder for the heart to pump blood to where it needs to go.

Tricuspid regurgitation is when the leaflets of the tricuspid valve are too loose, allowing too much back flow. This again makes it harder for the heart to pump blood to where it needs to go.

Both of these conditions may be called tricuspid valve disease and require medical attention.

What Are the Symptoms of Tricuspid Valve Disease?

The symptoms of tricuspid valve disease can include irregular heartbeat, fatigue, or discomfort in the neck. In severe cases, tricuspid valve disease can look like heart failure and include abdominal pain and shortness of breath.

What Is the Difference between Tricuspid Valve Repair and Replacement?

Damaged tricuspid valves can be surgically repaired or replaced.

A tricuspid valve repair procedure involves working on the patient's original tricuspid valve. Two major techniques are employed in tricuspid valve repair.

Leaflet patching: In tricuspid valves that are too loose, tissue can be used to fill in leaky parts so that tricuspid regurgitation no longer occurs.

Annulus support: The annulus is the central piece of tissue in a mitral valve that controls the leaflets. A synthetic or tissue-based ring is used to restore the annulus to its proper size and shape.

Alternatively, some surgeons choose to replace the faulty tricuspid valve completely. This involves the removal of the patient's original tricuspid valve and its replacement with a mechanical or biological valve. Each option offers its own advantages and disadvantages.

A mechanical valve is usually made from carbon, plastic, or metal and can last a long time. Because they are durable, mechanical valves generally do not need to be replaced regularly. However, they tend to attract blood clots and require the patient to take blood thinners for the rest of his or her life.

A biological valve is made from animal tissue. Because the material these valves are made from resembles the patient's original tissue, no blood clotting is caused. However, biological valves eventually fail and need to be replaced, usually within twelve to fifteen years.

It is important for the patient to discuss his or her options with a doctor or healthcare provider about the choice between a mechanical and a biological valve.

What Is the Procedure for a Tricuspid Valve Repair or Replacement Surgery Like?

Though the techniques for a tricuspid valve repair and a replacement are different, surgeons employ similar methods to get access to the heart for surgery. All of the major traditional procedures can be minimally invasive.

Prior to making any incision, patients will be put under general anesthesia. This means the patient will be asleep and not experience any pain.

A surgeon generally makes a incision at the breastbone to divide the sternum for access to the heart.

ANOTHER option is the right thoracotomy approach, which allows surgeons to make a small incision on the right side of the ribcage to reach the heart.

Once the procedure is completed, the surgeon will close any incision he or she has made. Catheters might be necessary to drain any fluid buildup during the procedure.

How Long Is the Recovery Period after Tricuspid Valve Repair or Replacement Surgery?

Recovery after tricuspid valve repair or replacement surgery generally takes about six weeks, but can take as long as several months depending on the health, age, and lifestyle of the patient.

Immediately after the surgery, which takes two to three hours, patients are taken to the intensive care unit (ICU), where they stay for at least one day. If the patient is deemed healthy, he or she may be moved to a regular hospital bed for another four to seven days.

Recovery after discharge takes about six weeks, and doctors recommend patients do not lift more than five pounds during this period.

What Are the Risks of Tricuspid Valve Repair or Replacement Surgery?

As with any surgery, tricuspid valve repair or replacement comes with a certain set of risks. These include bleeding, infection, blood clotting, or breathing problems.

Mechanical valves used as replacement valves are especially linked with blood clotting, which can lead to stroke.

Overall, tricuspid valve repair or replacement is extremely safe. For best results, choose a hospital that performs a large volume of these procedures.