Tricuspid Valve Surgery

Tricuspid Valve Surgery

The tricuspid valve is located on the right side of the heart between the bottom and top chambers (ventricle and atrium, respectively). A faulty tricuspid valve can be repaired (most often) or replaced. The selection of surgery will depend on individual case. Indication for mitral valve surgery follows complex guidelines, summarized as:

• In isolation, when there is severe damage to the valve, either obstruction (also called ‘stenosis’) or leakage (‘regurgitation’ or ‘insufficiency’)
• When there is moderate/severe damage to the valve and another cardiac surgery is necessary (e.g. mitral or aortic valve surgery) – the most common indication
• Infection of the tricuspid valve

The Surgery

Conventionally, the heart is accessed via a vertical incision and spreading of the breastbone (called ‘sternum’). Cardiopulmonary Bypass and cardiac preservation are then established.

The heart (specifically the right top chamber or right atrium) is opened and the valve is inspected. In the vast majority of cases, tricuspid repair is possible by suturing a ring around the valve. Otherwise the valve is replaced with a prosthesis (most commonly a tissue valve). Care is taken to clear all debris. The artificial valve prosthesis is then stitched to the heart.

The blood supply to the heart is resumed and it starts to beat again. Sometimes, a small electric shock is used to re-establish normal rhythm. Finally, the heart takes over the circulation again and the heart-lung machine is disconnected.

Afterwards, the surgeon controls potential sites of bleeding and inserts chest drains. A temporary pacemaker wire is also inserted. Drains and wires are removed in ICU or ward when no longer required.

The breastbone is closed with stainless steel wires. They will remain in your bone and should not activate metal detectors.

Choice of Prosthetic Valve

In a nutshell, there are 2 types of heart valve substitutes: tissue and mechanical prosthesis.

Although valve preference is individual, the most used valve in the tricuspid position is by far a tissue prosthesis.

The patient’s specific situations should be discussed with the surgeon so that a shared decision-making about the choice of valve type is achieved. This choice is influenced by several factors, including patient age, values, and preferences; expected bioprosthetic valve durability, avoidance of patient-prosthesis mismatch (when the size of the vale is too small for the size of the patient), and the potential need for and timing of re-intervention; and the risks associated with long-term VKA anticoagulation after a mechanical valve replacement. Read more.

Commonly Associated Procedures with SAVR

Coronary Artery Bypass, Mitral Valve Surgery, and Aortic Valve Surgery.

Associated Risks

Cardiac surgery is routinely performed all over the world. Australia ranks very well internationally, reflecting a high standard of care from both the operative setup and the hospital systems. As with any medical procedure, in a small number of cases, complications (adverse events) may occur.

The 5 major risks are bleeding and blood transfusion, mediastinitis (infection deeper to the chest bone), heart attack, stroke and even death. Other risks include need for pacemaker and organ failure (e.g. heart, lungs, kidneys).

The risk of infections, heart and lung problems and thrombosis increases with diabetes, obesity and smoking.

Please speak to your surgeon regarding your individual circumstances and any questions or doubts you may have.

For information about associated risks of cardiac surgery, please click here.