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A Journal on Heart and Vascular Diseases

Official Journal of the Italian Society of Angiology and Vascular Pathology
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Minerva Cardioangiologica 2018 Apr 11

DOI: 10.23736/S0026-4725.18.04687-X


language: English

Tricuspid valve surgery: repair and replacement


Department of Cardiovascular Surgery, Mount Sinai Medical Center, New York, NY USA


The tricuspid valve has historically received less attention than any other cardiac valve with regard to pathophysiology and surgical management. The tricuspid valve is part of a complex functional apparatus that includes the right atrium, right ventricle, and pulmonary circulation. Functional tricuspid regurgitation is the most common tricuspid valve disease and it occurs secondary to dilatation of tricuspid annulus and/or tethering of valve leaflets from right ventricular dilatation and dysfunction. However, recent expansion in the use of right-sided transvenous devices such as pacemakers and implantable defibrillators has been met with a parallel increase in the risk of organic tricuspid disease. Recent data suggest that tricuspid regurgitation is not benign and many patients will benefit from intervention at the time of left-sided valve surgery, or early in isolated tricuspid valve disease. This review describes the various surgical options and strategies in the treatment of common tricuspid valve diseases. Current American and European guidelines advocate for a more proactive surgical approach in the treatment of tricuspid regurgitation and/or annular dilatation at the time of left-sided valve surgery. Tricuspid annuloplasty is the preferred technique given its superior long-term outcomes. This renewed interest in surgical repair has been ushered by the development of a newer generation of tricuspid annuloplasty rings, as well as technological strides in transcatheter therapies which now extend to include tricuspid pathologies in otherwise inoperable patients with advanced tricuspid disease and cardiomyopathy. Tricuspid disease is not a benign entity. Aggressive approach to surgical management as well as prophylactic interventions are widely adopted. Tricuspid surgery however, remains an area of controversy in cardiac surgery, although surgical repair remains the gold standard for functional tricuspid regurgitation with replacement reserved for advanced or organic tricuspid disease. Transcatheter therapy is primarily directed toward non-surgical patients and is not included in this review.

KEY WORDS: Tricuspid regurgitation - Functional tricuspid disease - Tricuspid repair - Annuloplasty - Replacement

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Publication History

Article first published online: April 11, 2018
Manuscript accepted: April 4, 2018
Manuscript received: March 26, 2018

Cite this article as

El-Eshmawi A, Dimosthenis P, Tang GH. Tricuspid valve surgery: repair and replacement. Minerva Cardioangiol 2018 Apr 11. DOI: 10.23736/S0026-4725.18.04687-X

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