Tricuspid Valve Surgery at Cleveland Clinic
Physicians in Cleveland Clinic’s Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute perform the largest number of valve procedures in the United States. They performed more than 2,900 in 2010, and more than 2100 of these were first-time valve operations; the others were reoperations.
Our cardiac surgeons are experienced in treating patients with complex heart valve problems, multiple valve problems and valve disease in combination with other types of heart disease. They also are experienced in treating high-risk patients, including the elderly, those with other medical conditions and patients who are obese.
What is Tricuspid Valve Disease?
The tricuspid valve is located between the heart’s right upper chamber (atrium) and lower chamber (ventricle). Its role is to make sure blood flows the correct way through the heart, from the right atrium down to the ventricle. The tricuspid valve has three leaflets, or flaps, that control blood flow and direction.
In some people, this valve does not function correctly, and they are said to have tricuspid valve disease. Tricuspid valve disease is rare compared with other types of valve disease. The most common form of tricuspid valve disease is tricuspid stenosis, which means the valve leaflets are stiff and do not open all the way. This makes the valve narrow and restricts the blood flow. Another form of valve disease is tricuspid regurgitation. Patients with this condition have leaflets that do not close all the way and blood leaks backwards across the valve instead of flowing into the ventricle. These conditions cause the heart to pump harder to move blood through the body.
Traditional Valve Repair
Valve repair is a technically challenging procedure, and the success and outcome depend on the surgeon’s experience and skill, as well as the condition of the patient’s valve. This is why you should have the procedure performed by a surgeon with experience in valve repair at a hospital where many of these procedures are performed each year.
Traditional tricuspid valve repair is an open-heart procedure. During the surgery, your heart is stopped so the surgeon can work on a still heart. A heart-lung bypass machine is used to circulate your blood through your body. At the Miller Family Heart, Vascular & Thoracic Institute, the heart surgeon and cardiologist often use transesophageal echocardiography during the operation to check the valve’s function before and after surgery. A surgeon who is skilled in heart valve repair can perform several different repair procedures to separate leaflets that have fused, repair leaflets that are torn and reshape parts of the valve, depending on the valve problem.
These techniques include:
Edwards MC 3 Annuloplasty System
Annulus support involves the use of a tissue-based or synthetic ring to reinforce the annulus, which is the ring of tissue at the base of the valve leaflets. This procedure restores the annulus to right size and shape and allows the leaflets to open and close completely.
Tricuspid valve repair using an annuloplasty ring is the preferred surgical approach for tricuspid regurgitation and may be performed for primary tricuspid disease or for combined cases with other valve surgery (mitral, aortic).
Research has shown that the Rigid prosthetic ring annuloplasty provides better long term outcomes <sup>2</sup>
Leaflet patching is used to treat tricuspid valve regurgitation. The surgeon repairs the torn leaflet with a patch to correct the leaking valve and eliminate blood backflow.
Tricuspid Valve Replacement
Although most patients have their valve repaired, some patients need the valve replaced. Your surgeon will determine which treatment is the best for you.
During valve replacement, the surgeon removes the patient's original valve and replaces it with either a biologic (tissue-based) or mechanical valve.
Biologic valves are made of pig (porcine), cow (bovine) or human (allograft or homograft) tissue. They last 15 to 20 years and do not require the patient to take anticoagulant (blood-thinning) medication for the rest of their life.
Lanyard and template handle assists with placement of ring
Mechanical valves are made of metal or carbon surrounded with a polyester knit fabric-covered ring. These valves last longer than biologic valves and require lifelong therapy with blood-thinning medication to reduce the risk of blood clots and stroke.
At the Miller Family Heart, Vascular & Thoracic Institute, 85 percent of valve replacement procedures in 2010 involved biologic valves.
Minimally Invasive and Robotically Assisted Valve Surgery
Minimally invasive surgery is an option for many patients with tricuspid valve disease. While traditional valve surgery is performed through a 6 – 8 inch incision through the breastbone (sternum), a minimally invasive approach may include:
- Smaller 3 inch incision through the breastbone
- Robotically assisted approach, which involves several small incisions in the chest wall.
- Right thoracotomy approach, which involves a small incision on the right side in between the rib cage
Anatomically correct design conforms to the 3-D tricuspid valve opening.
The benefits of minimally invasive surgery are:
- Reduced blood loss
- Reduced surgical trauma
- Shorter hospital stay
Cleveland Clinic heart surgeons have helped develop many of the minimally invasive surgical techniques used in valve surgery.
Your surgeon will evaluate your overall medical condition, your heart’s anatomy and function, and the severity and extent of your valve disease to determine if you are a candidate for a minimally invasive valve procedure.
Complex Tricuspid Valve Surgery
Patients with tricuspid valve disease often have other heart conditions, such as mitral or aortic valve disease, an abnormal heart rhythm (atrial fibrillation) or have had previous heart surgery, such as a coronary bypass, which is causing problems with the tricuspid valve.
Cleveland Clinic surgeons are experienced in performing tricuspid valve surgery with other procedures, such as those to treat other types of valve repair and abnormal heart rhythms. The surgeons are also experienced in operating on patients with infected heart tissue (endocarditis).