Tricuspid Valve Replacement / Repair
Tricuspid Valve Replacement (TVR) and Tricuspid Valve Repair (TVr) are surgical procedures used to treat diseases of the tricuspid valve, one of the four valves in the heart that regulates blood flow between the right atrium and right ventricle. When this valve malfunctions, it can lead to conditions like tricuspid regurgitation (when the valve leaks and allows blood to flow backward) or tricuspid stenosis (when the valve is narrowed, obstructing blood flow).
Tricuspid Valve Replacement (TVR)
In tricuspid valve replacement, the damaged valve is removed and replaced with a prosthetic valve.
The replacement valve can be:
- Mechanical Valve: Made from durable materials such as metal or plastic. Mechanical valves last a long time but require the patient to take lifelong blood-thinning medication (anticoagulants) to prevent blood clots.
- Biological (Tissue) Valve: Made from animal tissue (usually from a pig or cow) or from a human donor. Biological valves may need to be replaced after 10-20 years but usually do not require lifelong anticoagulation.
When is Tricuspid Valve Replacement necessary?
- Severe tricuspid regurgitation: When blood leaks back into the right atrium, causing heart failure or symptoms like fatigue, swelling in the legs, or fluid buildup in the abdomen.
- Severe tricuspid stenosis: When the valve becomes narrowed, impeding blood flow from the right atrium to the right ventricle.
- When the tricuspid valve is too damaged to be repaired.
Tricuspid Valve Repair (TVr)
Tricuspid valve repair aims to preserve the patient’s native valve by correcting structural issues and restoring its normal function. Repair is generally preferred over replacement when possible because it retains the natural valve and usually results in better long-term outcomes without the need for anticoagulants.
Techniques used in Tricuspid Valve Repair:
- Annuloplasty: The most common type of tricuspid valve repair, where a ring is placed around the valve’s annulus (base) to tighten it and restore proper leaflet function. This is used to correct valve leakage (regurgitation).
- Leaflet repair: If the valve’s leaflets are misshapen or damaged, they can be reshaped, stitched, or reinforced to improve their function.
- Chordal repair: The chordae tendineae, which anchor the valve leaflets, can be repaired or replaced if they are stretched or torn.
- De Vega technique: A suture annuloplasty method where stitches are placed around the valve to reduce the size of the valve opening and reduce regurgitation.
When is Tricuspid Valve Repair preferred?
- Tricuspid regurgitation: When the valve is leaking but not structurally too damaged, repair is preferred to avoid the need for a prosthetic valve.
- To avoid the complications of replacement, including the need for anticoagulation (if using a mechanical valve).
- In younger patients or those with other cardiac conditions, where preserving the natural valve is beneficial in the long term.
