Tricuspid valve repair and tricuspid valve replacement

Overview

Tricuspid valve repair and tricuspid valve replacement are surgeries to treat a damaged or diseased tricuspid valve. The tricuspid valve is one of four valves that control blood flow through the heart. It separates the upper and lower right chambers of the heart.

A damaged or diseased tricuspid valve can change the proper direction of blood flow. The heart must work harder to send blood to the lungs and the rest of the body.

Tricuspid valve repair and tricuspid valve replacement can help improve blood flow and reduce symptoms of heart valve disease. Tricuspid valve repair or replacement may be done as open-heart surgery or as minimally invasive heart surgery. Sometimes, tricuspid valve disease may be treated with a catheter-based procedure.

Why it's done

Tricuspid valve repair and tricuspid valve replacement are done to fix a damaged or diseased tricuspid valve.

Some tricuspid valve conditions are not well treated with just medicine. Surgery may be needed to reduce symptoms and the risk of complications, such as heart failure.

Reasons why tricuspid valve repair or tricuspid valve replacement may be recommended:

• Tricuspid valve regurgitation. The valve doesn't close properly. As a result, blood leaks backward into the upper right chamber. Many health conditions can lead to tricuspid valve regurgitation. One example is a heart problem present at birth called Ebstein anomaly.
• Tricuspid valve stenosis. The tricuspid valve is narrowed or blocked. It's harder for blood to move from the upper right heart chamber to the lower right heart chamber. Tricuspid valve stenosis may occur with tricuspid regurgitation.
• Tricuspid atresia. This is a heart defect present at birth, also called a congenital heart defect. The tricuspid valve isn't formed. Instead, there's solid tissue between the heart chambers, which restricts blood flow. As a result, the lower right heart chamber isn't fully developed.

If tricuspid valve disease isn't causing symptoms, surgery may not be needed.

The type of tricuspid valve surgery needed depends on:

• The severity of tricuspid valve disease, also called the stage.
• The symptoms.
• Age and overall health.
• Whether the condition is getting worse.
• Whether surgery is needed to correct another valve or heart condition.

Surgeons recommend tricuspid valve repair when possible, as it saves the heart valve and improves heart function. Having tricuspid valve repair instead of replacement may reduce the need for long-term blood thinners.

Tricuspid valve surgery may be done at the same time as other heart valve surgeries.

Risks

All surgery involves some risk. Risks of tricuspid valve repair and tricuspid valve replacement depend on:

• The type of valve surgery.
• Your overall health.
• The expertise of the surgeons.

If you need tricuspid valve repair or replacement, consider being treated at a medical center with a multidisciplinary team of heart surgeons and care providers trained and experienced in heart valve surgery.

Risks associated with tricuspid valve repair and tricuspid valve replacement surgery may include:

• Bleeding.
• Blood clots.
• Failure of a replacement valve.
• Irregular heart rhythms, called arrhythmias.
• Infection.
• Stroke.
• Death.

How you prepare

Before tricuspid valve repair or replacement, you usually have tests to get more information about your heart and heart valves. For example, you may have an echocardiogram.

Ask your healthcare professional any questions you may have about tricuspid heart valve surgery. Your care team tells you what to expect during and after surgery and any potential risks.

Before the day of tricuspid valve surgery, talk to your caregivers about your upcoming hospital stay. Discuss any help you may need when you return home.

Food and medications

Talk to your healthcare team about:

• When or if you can take your regular medications before surgery.
• When or if you should stop eating or drinking the night before surgery.

Clothing and personal items

Your healthcare team may recommend that you bring several items to the hospital including:

• A copy of your advance directive or living will.
• A list of your medicines.
• Eyeglasses, hearing aids or dentures.
• Items that may help you relax, such as portable music players or books.
• Loose-fitting, comfortable clothing.
• Personal care items such as a brush, comb, shaving equipment and toothbrush.

During surgery, do not wear:

• Contact lenses.
• Dentures.
• Eyeglasses.
• Jewelry.
• Nail polish.

What you can expect

Before

A member of your care team may shave hair from the body area where the surgical cuts, called incisions, will be made. A special soap is usually used to wash your skin to help prevent infection.

During

Tricuspid valve repair or replacement may be done as open-heart surgery or as minimally invasive heart surgery. Open-heart surgery involves making a surgical cut, called an incision, through the middle of the chest to reach the heart. Minimally invasive heart surgery involves much smaller incisions than those used in open-heart surgery. Sometimes, tricuspid valve disease may be treated using thin, flexible tubes called catheters.

For most tricuspid valve repair and tricuspid valve replacement surgeries, you get a combination of medicines to put you in a sleep-like state. This is called general anesthesia. You are connected to a heart-lung bypass machine, which keeps blood moving through the body during the surgery.

Tricuspid valve repair

Heart doctors recommend heart valve repair when possible. It saves the heart valve and avoids the need for a replacement heart valve. It also can help save heart function.

Tricuspid valve repair is usually done with open-heart surgery. Sometimes, a tricuspid valve can be repaired with minimally invasive surgery.

During tricuspid valve repair, a surgeon might:

• Patch holes or tears in the valve flaps.
• Reconnect valve flaps, called leaflets.
• Reshape or remove extra valve tissue so that the flaps can close tightly.
• Replace cords that support the valve for better support.
• Separate valve flaps that have joined together.
• Tighten or strengthen the ring around the valve, called the annulus.

If tricuspid regurgitation is caused by Ebstein anomaly, heart surgeons may do a type of valve repair called a cone procedure. During a cone procedure, the heart surgeon separates the flaps that close off the tricuspid valve from the underlying heart muscle. The flaps are then rotated and reattached.

Minimally invasive tricuspid valve repair

Minimally invasive tricuspid valve repair typically involves smaller surgical cuts and a shorter hospital stay than traditional open-heart surgery.

One minimally invasive method to treat infants and children with tricuspid valve stenosis is balloon valvuloplasty. It also is called balloon valvotomy.

During balloon valvuloplasty, a surgeon places a thin, hollow tube called a catheter into a blood vessel, usually in the groin, and guides it to the heart. A balloon on the tip of the catheter is inflated. This widens the narrowed tricuspid valve. The balloon is deflated and removed.

Treatments using catheters are currently being developed for some patients with tricuspid regurgitation who can't have surgery. A healthcare professional may discuss this option in special circumstances.

Tricuspid valve replacement

If the tricuspid valve can't be repaired, surgery may be done to replace the valve. Tricuspid valve replacement surgery may be done as open-heart surgery or minimally invasive surgery.

During tricuspid valve replacement, a surgeon removes the damaged or diseased valve. The valve is replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve.

Together, you and your healthcare team talks about the risks and benefits of each type of valve to determine the one that's best for you.

If you have a mechanical valve, you need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves don't require lifelong blood thinners. But they can wear down over time and may need to be replaced.

Valve-in-valve replacement

If you have a biological tissue tricuspid valve that's no longer working, valve replacement may be done using thin, flexible tubes called catheters instead of open-heart surgery. The doctor inserts the catheter into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the catheter and is placed into the existing biological valve.

After

After tricuspid valve repair or replacement surgery, you generally stay in the hospital for several days. How long you stay depends on your condition and specific type of tricuspid valve surgery.

During the hospital stay, you may have:

• An IV to receive fluids and medicines.
• Tubes to drain urine from your bladder.
• Tubes to drain fluid and blood from your heart and chest.

Your care team will:

• Check for infection at your incision sites.
• Regularly check your blood pressure, breathing and heart rate.
• Help you manage pain after surgery.
• Ask you to take longer and longer walks to increase your activity.
• Show you how to do breathing exercises as you recover.

Your healthcare team gives you instructions to follow after tricuspid valve repair or replacement surgery. These instructions typically have details about the following:

• The medicines you are taking.
• The warning symptoms of infection.
• How to care for your surgical cuts.
• How to manage pain.
• The side effects of surgery.

Results

How long it takes to recover from tricuspid valve repair or replacement surgery depends on the specific treatment, any complications and your overall health before the surgery.

Your healthcare professional tells you when you can return to daily activities, such as working, driving and exercise.

After tricuspid valve repair or replacement surgery, you need regular health checkups. You may have several tests to check your heart to make sure the tricuspid valve is working properly.

After tricuspid valve surgery, it's important to follow a heart-healthy lifestyle. Try these tips:

• Do not smoke or use tobacco.
• Eat a healthy diet.
• Get regular exercise.
• Manage your weight.
• Control stress.

Your care team also may suggest participating in cardiac rehabilitation. It is a personalized education and exercise program to help you recover after heart surgery and improve your overall health.