Tricuspid Valve Repair and Replacement

What are tricuspid valve replacement and repair?

Tricuspid valve replacement and repair are procedures that fix issues with your heart’s tricuspid valve.

Your tricuspid valve is one of four valves that manage blood flow through your heart. It’s on the right side of your heart, between the upper chamber (atrium) and lower chamber (ventricle). It ensures that blood flows in the correct direction — from the right atrium down to the right ventricle. A tricuspid valve has three flaps (leaflets) that open and close as blood flows through it.

It’s not easy to hear that your heart isn’t working well. But it’s good to know that valve repair or replacement can improve your daily life and help you do the things you want to do.

What does tricuspid valve replacement or repair treat?

Tricuspid valve replacement or repair treats tricuspid valve disease conditions. These affect how well your valve works. The main types are:

• Tricuspid regurgitation. Your valve doesn’t close tightly enough, allowing blood to leak backward.
• Tricuspid stenosis. Your valve’s leaflets (flaps) are too stiff, which can restrict blood from flowing.

When your tricuspid valve doesn’t function correctly, your heart may have to work harder to supply your body with blood. This can cause symptoms like fatigue and shortness of breath. It also may lead to complications like heart failure.

Is it better to repair or replace the tricuspid valve?

Usually, repairing your tricuspid valve and keeping your own heart tissue is best. But you may need a replacement valve if you have too much damage on your valve and surrounding tissue.

There are two types of replacement valves: biological and mechanical. A biological valve may come from an animal or deceased human donor. A mechanical valve is made completely out of synthetic material.

If you receive a valve from an animal or human donor, you may not need to take blood thinners afterward. But mechanical valves increase the risk of blood clots, so you’ll need to take blood thinners for life.

How common is this procedure?

Tricuspid valve surgery is rare, especially as an isolated surgery. This is an operation where a surgeon doesn’t fix anything else. Surgeons performed about 5,000 isolated tricuspid valve surgeries in the U.S. from 2004 through 2013. Many people with tricuspid valve issues didn’t receive surgery in the past because of the high risk. That may be changing with newer procedures that offer a minimally invasive option.

How should I prepare for tricuspid valve replacement or repair?

Before surgery to repair or replace your tricuspid valve, you may:

• Learn what to expect before, during and after surgery
• Discuss potential risks of the surgery with your healthcare team
• Ask questions about the procedure you’re having
• Sign a form giving consent for surgery
• Plan for your recovery, including medications and any help you’ll need at home

You may need to take certain tests before tricuspid valve surgery. These tests ensure you’re healthy enough for surgery and help your provider plan the procedure. Tests may include:

• Blood tests
• Electrocardiogram (EKG)
• Imaging tests like a chest X-ray or echocardiogram to take pictures of the inside of your heart

What happens during tricuspid valve surgery?

Surgeons often perform tricuspid valve surgery with an open-heart approach. This involves an incision either through the middle of your chest or from the side.

The surgical team will:

1. Give you anesthesia to put you to sleep
2. Make an incision in your chest to gain access to your heart
3. Give you medication to stop your heart
4. Connect you to a heart-lung bypass machine to keep your blood circulating
5. Perform the specific type of tricuspid valve replacement or repair

Depending on the valve problem, there are several approaches to tricuspid valve surgery. The surgeon might:

• Perform annuloplasty to reinforce the annulus, a ring of tissue at the base of the valve’s leaflets
• Remove the valve and replace it with a biological or mechanical one
• Reshape the valve using sutures (stitches)
• Separate the valve’s leaflets if they’re stuck together
• Sew or patch any torn leaflets

Can the tricuspid valve be repaired or replaced without open-heart surgery?

There are less invasive options for tricuspid valve surgery that use smaller incisions and may not require a bypass machine. Your surgeon will let you know which type of surgery is best for you. Minimally invasive options include:

• Right thoracotomy approach. Surgeons perform this procedure through a small incision on the right side of your chest (between ribs). They often use it for tricuspid valve surgery and mitral valve repair.
• Robotically assisted surgery. Robotically assisted tricuspid valve repair involves several small incisions in your chest wall. Robotic technology helps your surgeon perform the procedure.
• Transcatheter tricuspid valve repair or replacement. Your healthcare team uses smaller incisions and threads a thin tube (catheter) through a vein to perform the procedure. This may include widening a valve’s narrow opening with valvuloplasty.

Can I have other procedures along with tricuspid valve surgery?

Yes, it’s common for surgeons to perform other procedures at the same time as tricuspid valve repair or replacement. For example:

• Catheter ablation for arrhythmia
• Coronary artery bypass for coronary artery disease
• Repair or replacement of your aortic valve or mitral valve

What happens after tricuspid valve repair or replacement?

After tricuspid valve surgery, you’ll probably stay in the hospital for a few nights. The length of your stay depends on several factors, including your overall health and the type of procedure you received.

Before you leave the hospital, your healthcare team will monitor you and order imaging tests to ensure the repair or replacement is working.

To prevent complications, you may have to take medications. These may include anticoagulants for blood clots and antibiotics for infection.

What are the benefits of tricuspid heart valve replacement and repair?

Tricuspid repair or replacement can:

• Correct a tricuspid valve disorder
• Help you take part in activities and complete daily tasks
• Help you live longer with tricuspid valve disease
• Lessen or eliminate symptoms like weakness, fatigue, shortness of breath and swelling in your abdomen, legs or feet

What are the risks or complications of tricuspid valve repair or replacement?

Tricuspid valve repair or replacement is invasive and has several potential risks, including:

• Bleeding
• Blood clots
• Heart rhythm issues (arrhythmia) or the need for a pacemaker
• Infection
• Stroke
• Heart failure
• Kidney failure
• Valve dysfunction despite replacement

What is the recovery time for a tricuspid valve replacement?

Recovery time after tricuspid valve repair or replacement depends on several factors, including your overall health. Most people need several months after open-heart surgery to return to normal activities. Recovery from transcatheter procedures is shorter — usually a few weeks.

How long does a replacement valve last?

A biological replacement valve can last 10 to 20 years. A mechanical valve can last indefinitely — possibly the rest of your life.

When should I call my healthcare provider after tricuspid heart valve replacement?

After tricuspid valve surgery, report any symptoms that could mean the valve or heart isn’t functioning well, like:

• Dizziness or lightheadedness
• Extreme fatigue
• Sudden weight gain
• Swelling in your feet or ankles

Also, call your healthcare provider if you have signs of infection, like:

• Chills
• Drainage from the incision
• Fever
• Pain that gets worse
• Redness around the incision site

Seek emergency medical help if you have any of these symptoms, which may indicate a life-threatening problem with heart function:

• Chest pain
• Pressure or tightness in your chest
• Sudden, severe shortness of breath
• Fainting