Surgical Management of Tricuspid Valve Disorders

Abstract

In recent years, there has been more appreciation for intraoperative assessment of valvular heart disease by the routine use of transesophageal echocardiogram (TEE), and corrective measures have been adopted to repair moderately regurgitating mitral and tricuspid valves. As recently as 10 years ago, asymptomatic regurgitant mitral valves in ischemic heart disease were not repaired, let alone the tricuspid valves. The popular belief was that pulmonary hypertension decreases after surgical correction of mitral valve stenosis or regurgitation, and then tricuspid regurgitation (TR) automatically disappears. In the recent years, however, it has become clear that the regurgitant pathology not only does not get better but can also even get worse resulting in heart failure (J Thorac Cardiovasc Surg 99(1): 124–33, 1990). There are significant differences in the outcomes of patients treated for TR before they have developed symptoms and the outcomes of patients treated after they develop symptoms. An incidental TR noticed during routine TEE examination during cardiac surgery, when corrected, will carry a lower mortality and morbidity as compared with a patient admitted with peripheral edema, hepatomegaly, elevated bilirubin, and symptoms of congestive heart failure. In the latter group, mortality ranges from 15 to 30%. This is more true for reoperations to correct recurrent TR, mainly due to right ventricular enlargement. In addition, the hospital length of stay is significantly increased while correcting low cardiac output syndrome.