Tricuspid Valve Replacement and Repair

Overview

Tricuspid valve repair and tricuspid valve replacement are treatments for conditions affecting the tricuspid valve in the heart. An unhealthy or malfunctioning tricuspid valve may cause problems with blood flow direction. To supply blood to the lungs and the rest of the body, the heart has to work harder.

The tricuspid valve is located between the ventricle and the atrium, the upper and lower chambers of the heart, on the right side. It is one of the four valves in the heart that regulate blood flow. It guarantees that blood travels from the right atrium to the right ventricle in the proper path.

Tricuspid valve repair and replacement procedures can improve symptoms and increase survival rates for individuals suffering from tricuspid regurgitation or tricuspid stenosis. Traditional tricuspid valve surgery usually entails open-heart procedures, but less invasive options like catheter-based procedures may also be suggested.

Reasons for undergoing the procedure

If the tricuspid valve malfunctions, the heart may need to exert more effort to circulate blood throughout the body. This can result in troublesome symptoms and potentially give rise to complications, including the risk of heart failure.

The decision to undergo tricuspid valve repair or tricuspid valve replacement is contingent upon several factors, including the severity and stage of the disease, the presence and nature of symptoms, the individual’s age and overall health, the progression of the condition, and whether surgery is also required to address other concurrent valve or heart issues.

In instances where tricuspid valve disease is asymptomatic, surgery may not be deemed necessary. Nonetheless, for cases in which medication alone proves insufficient for addressing all forms of tricuspid valve disorders, surgical intervention may be advised.

The conditions that may necessitate tricuspid valve repair or tricuspid valve replacement include:

• Tricuspid valve regurgitation: This condition can be caused by various health conditions, including congenital heart defects like Ebstein anomaly, where blood flows backward through the valve. With this condition, the tricuspid valve fails to close tightly, leading to the backward leakage of blood into the upper right heart chamber.
• Tricuspid valve stenosis: This condition can sometimes coexist with tricuspid regurgitation. Tricuspid stenosis is characterized by stiff valve leaflets, resulting in the restriction of blood flow.
• Tricuspid atresia: This condition is characterized by a structural abnormality that restricts the flow of blood, leading to underdevelopment of the right ventricle, the lower right heart chamber. This congenital heart defect involves the absence of a properly formed tricuspid valve, replaced by solid tissue between the heart chambers.

Opting for tricuspid valve repair rather than replacement can potentially lessen the requirement for long-term blood thinners. Whenever feasible, tricuspid valve repair is the preferred approach as it preserves the heart valve and enhances heart function. Replacement is typically recommended only when the valve and surrounding tissue exhibit severe damage.

Risk

Repairing or replacing a tricuspid valve requires invasive surgery and carries several potential risks, such as:

• Bleeding
• Blood clots
• Infection
• Valve failure even after the replacement
• Heart rhythms problems
• Stroke
• Death

Before the procedure

Before undergoing tricuspid valve surgery, patients will receive detailed information about the pre-operative, intra-operative, and post-operative phases of the procedure. Their healthcare provider will thoroughly explain potential surgical risks, address any questions or concerns, and obtain informed consent through a signed form.

• Tests: Several tests may be required to assess one’s overall health and plan for the procedure. These tests could involve blood tests, an electrocardiogram (EKG) to monitor heart activity, and imaging tests like chest X-rays or ultrasounds to capture internal images of the heart, particularly the structure and function of the tricuspid valve.
• Medications, food, and drink intake: Patients may be advised about the recommended timeline for discontinuing food and drink intake the night before the surgery, including intake of regular medications.
• Clothing and personal items: Before surgery, bring important items to the hospital as suggested by the healthcare providers, such as an advance directive, medication list, eyeglasses, and comfort items. Pack loose-fitting clothes and personal care items. During surgery, avoid wearing contact lenses, dentures, eyeglasses, jewelry, and nail polish for safety reasons.

Furthermore, the healthcare provider will aid in the preparation of post-surgery recovery, including outlining medication schedules and arranging for any essential support or assistance that may be needed at home.

During the procedure

The majority of tricuspid valve replacement and repair procedures involve the administration of anesthetic medications to ensure one’s comfort during the treatment. An IV is also inserted in the forearm or hand for administering fluids and medications.

The patient might be linked to a heart-lung bypass machine, which maintains blood circulation throughout the body while undergoing heart valve surgery.

A catheter-based technique, open heart surgery, or minimally invasive heart surgery can all be used to replace or repair the tricuspid valve.

• Tricuspid valve repair: The cone procedure is a type of valve repair performed to address tricuspid regurgitation associated with Ebstein anomaly. This technique involves separating the leaflets that close the tricuspid valve from the underlying heart muscle, followed by rotating and reattaching these leaflets.Traditionally, tricuspid valve repair involves open heart surgery and a sternotomy or opening of the chest bone. Tricuspid valve repair surgery includes procedures such as patching holes or tears, reconnecting valve flaps, adjusting or removing excess tissue, replacing supporting cords, separating fused flaps, and reinforcing the valve ring.
  After the procedure, healthcare providers secure the bone with wires to prevent any movement and promote healing. In some cases, tricuspid valve repair can be achieved through minimally invasive surgery.
• Minimally invasive tricuspid valve repair: Tricuspid valve surgery has less invasive alternatives involving smaller incisions, potentially eliminating the need for a bypass machine. Currently, there are ongoing developments in catheter-based procedures to address tricuspid valve regurgitation, especially for patients who may not be suitable candidates for surgery.
  Balloon valvuloplasty, also referred to as balloon valvotomy, is a procedure that involves inserting a thin catheter into a blood vessel, typically in the groin, and guides it to the heart. The catheter’s tip contains an inflatable balloon that, when expanded, widens the narrowed tricuspid valve. Subsequently, the balloon is deflated and removed. This minimally invasive technique is commonly employed for treating tricuspid valve stenosis in infants and children.
• Tricuspid valve replacement: Replacement valves come in two types: biological and mechanical. Biological valves are derived from animals or deceased human donors and may eliminate the need for post-surgery blood thinners. While mechanical valves are manufactured medical devices which heighten the risk of blood clots, requiring a lifelong use to blood thinners.
  In tricuspid valve replacement, the impaired valve is removed and substituted with either a mechanical valve or a biological tissue valve. Both minimally invasive and open-heart surgery can be used to replace a tricuspid valve.
  In cases where a biological tissue tricuspid valve is dysfunctional, a minimally invasive catheter procedure may be employed as an alternative to open-heart surgery for valve replacement. During a valve-in-valve procedure, a thin catheter is inserted into a vein, guided to the tricuspid valve with X-rays, and a replacement valve is introduced through the catheter into the existing biological valve.

After the procedure

After tricuspid valve repair or replacement surgery, postoperative instructions involving details on prescribed medications, identification of warning signs and symptoms of infection, guidance on caring for incisions, pain management strategies, and information on potential side effects of the surgical procedure will be provided.

Throughout the hospital stay, patients may receive fluids and medications through an intravenous (IV) line, and they may have tubes in place for draining urine from the bladder, as well as tubes to remove fluid and blood from the heart and chest.

One may be prescribed with medications aimed at preventing potential complications, such as anticoagulants to prevent blood clots and antibiotics to guard against infections. Imaging tests may be ordered to verify the effectiveness of the tricuspid valve repair or replacement.

The healthcare provider may also do the following:

• Inspect incision areas for signs of infection
• Aid in pain management following surgery
• Monitor the heart rate, respiration, and blood pressure
• Teach the best way to practice breathing techniques during recovery
• Request to gradually extend the duration of the walks in order to enhance physical activity

People who undergone the procedure typically remain hospitalized for several days, with the duration determined by individual health conditions and the specific type of tricuspid valve procedure performed.

Outcome

After undergoing tricuspid valve repair or replacement surgery, it is crucial to participate in regular health checkups, which may encompass a range of tests designed to track heart health and verify the tricuspid valve’s effective operation.

Symptoms that may indicate heart or valve dysfunction include:

• Feet or ankle inflammation
• Feeling lightheaded or dizzy
• Severe exhaustion
• Rapid weight gain

It is also important to take note of the signs of infection and possible complications. Immediate medical assistance is necessary if symptoms suggest a potentially life-threatening issue with heart function, including chest pain, pressure or tightness in the chest, sudden severe shortness of breath, or fainting.

Consult a healthcare provider if any signs of infection are experienced, such as chills, drainage from the incision, fever, worsening pain, or redness around the incision site after the tricuspid valve surgery.

The duration of recovery after tricuspid valve repair or replacement surgery typically varies depending on the specific procedure, potential complications, and the individual’s overall health before the surgery.

Cardiac rehabilitation, a specialized program that combines education and exercise to improve overall cardiovascular health, can play a crucial role in the recovery process following heart valve surgery. This program is designed to promote a heart-healthy lifestyle by emphasizing regular exercise, weight management, a healthy diet, and other important aspects of cardiovascular health.

Healthcare providers will provide guidance on when it’s safe to resume daily activities such as work, driving, and exercise as part of the postoperative care plan.