Tricuspid Valve RepairEdit

Tricuspid valve repair is a set of surgical and percutaneous techniques aimed at correcting dysfunction of the tricuspid valve, typically to prevent or reverse significant regurgitation or stenosis while preserving the native valve when possible. The tricuspid valve lies between the right atrium and right ventricle and normally operates with a delicate balance of leaflet motion, chordal support, and annular geometry. Dysfunction can arise from primary disease of the valve apparatus or from secondary changes related to right-sided heart dilation, left-heart disease, or elevated pulmonary pressures. In practice, repair is favored when feasible, because preserving the patient’s own valve tends to maintain right ventricular function better over the long term than replacement.

Because the tricuspid valve frequently becomes dysfunctional in the setting of other cardiac disease, repair is commonly performed in conjunction with surgery on the left heart, such as mitral valve repair or replacement. Guidelines and experienced centers emphasize patient selection and timing, since right-heart reserve and the degree of annular dilation influence outcomes. For many patients, repair offers durable improvement in symptoms and quality of life with lower risk of prosthetic complications compared with valve replacement. See Tricuspid regurgitation and Tricuspid valve for related anatomy and disease concepts, and consider the broader context of Valvular heart disease management.

Indications and patient selection

Repair is considered for primary tricuspid valve disease (intrinsic leaflet or apparatus pathology) and for secondary or functional disease where the valve is structurally capable of coapting after addressing the driving right-heart or left-heart pathology. Symptomatic severe tricuspid regurgitation or progressive dilation with evidence of right-sided failure frequently prompts repair, especially when the patient is already undergoing surgery for another valve or for a congenital defect. In some cases, moderate or even mild TR may be treated preventively if there is a high risk of progression due to annular dilation or right ventricular remodeling. Decision-making relies on imaging assessments, most notably echocardiography, which estimates regurgitant severity, annular size, leaflet tethering, and right ventricular function, and on clinical evaluation of symptoms and exercise capacity. See Echocardiography and Right ventricle for more on assessment.

Techniques

Annuloplasty and leaflet repair

The central aim of most tricuspid repair procedures is to restore coaptation of the leaflets by reducing annular dilation and correcting tethering. Techniques include:

Ring or suture-based annuloplasty to reduce and stabilize the tricuspid annulus (often involving a prosthetic ring or a De Vega-style annuloplasty). See Annuloplasty and Tricuspid valve.
Leaflet augmentation or resection in select primary disease cases to improve coaptation, with careful preservation of chordal support.
Edge-to-edge (Alfieri) repair, which sutures corresponding portions of the anterior and septal leaflets to improve seal. See Alfieri technique and Tricuspid valve.

Concomitant procedures

Repair is frequently performed together with other cardiac operations, notably Mitral valve repair or replacement or, less commonly, procedures on the aortic valve or right-sided structures. The goal is to address all contributing factors to tricuspid dysfunction while minimizing additional risk. See Mitral valve for context on concomitant left-heart procedures and their impact on tricuspid repair decisions.

Transcatheter and minimally invasive approaches

Transcatheter therapies for the tricuspid valve are evolving. These include percutaneous annular reduction devices and edge-to-edge methods that mimic the surgical Alfieri technique, delivered via venous access in selected patients who are at higher risk for open surgery. See Transcatheter valve therapy and Transcatheter tricuspid therapy for overview of non-surgical options.

Outcomes and risks

Repair generally preserves native valve tissue, which is associated with favorable right ventricular preservation and avoidance of prosthetic valve-related complications. Outcomes depend on the underlying cause of regurgitation, the degree of right ventricular dysfunction, and whether repair is performed in isolation or alongside other valve procedures. In experienced centers, isolated tricuspid repair for severe regurgitation can achieve meaningful symptomatic relief and durable results, though recurrence of regurgitation can occur, particularly if right-sided pressures remain elevated or if annular dilation recurs after surgery. Perioperative risk is influenced by patient age, comorbidities, and the complexity of concurrent operations. See Operative mortality and Right heart function discussions for broader context.

Controversies and debates

Timing and indication: There is ongoing debate about whether to repair the tricuspid valve proactively during left-sided valve surgery when mild or moderate TR is present but the patient is asymptomatic. Proponents argue that early repair reduces the risk of late deterioration and right-heart remodeling, while opponents point to added operative time and complexity in some patients. See Mitral valve discussions on concomitant procedures for related debates.
Repair versus replacement: In some scenarios, especially with complex valve pathology or severely distorted leaflet tissue, replacement may be considered. Repair aims to preserve valve apparatus and right ventricular function, but durability can depend on technical factors and disease biology. See Valve replacement for comparisons.
Transcatheter options: As transcatheter approaches mature, questions remain about long-term durability, patient selection, and how these therapies fit with surgical repair. Ongoing trials and registry data continue to shape practice.