The Tricuscupid


Indications for Repair of Tricuspid Valve

Notes From


How does Tricuspid Regurgitation Happen?

80% 2/2 RV enlargement –> annular dilation/leaflet tethering, itself 2/2 LV failure or RV volume/pressure overload

Rheumatic, congenital, endocarditis, traumatic, pacemaker, myxomatous less common


-decreased exercise tolerance

-RV failure symptoms (edema, ascites, congested liver, decreased appetite), afib

Effective regurgitant orifice (ERO) and proximal isovelocity surface area (PISA) used on echo to evaluate, dependent on volume status with ERO >0.4 cm2 used as criteria

Indications and Timing of Surgery

Performed in isolation or at time of left sided valve surgery

In Isolation

-Severe TR (ERO>0.4CM2) and isolated TR a/w excess m&m

-recent guidelines (class IIa) rec’d Tricuspid repair on its own when patients are symptomatic, including congestive hepatopathy, preferably before significant RV dysfx

-performing isolated Tricuspid repair AFTER left sided heart surgery has typically waited until severe symptoms arise leading to high M&M, however when done before severe symptoms and before significant RV dysfx outcomes are reasonable

-Severe Pulm HTN or significant RV dysfx is considered relative contraindication to surgery


TR Surgery at time of Left-sided Valve Surgery

-usually good idea because: TR doesn’t predictably improve after left sided tx, it’s not that risky to add repair of tricuspid to left repair, and reops for isolated Tricuspid repair after left repair is risky

-Risk factors for progression of TR: tricuspid annulus dilatation: ERO >40mm or 21mm/m2 on TTE or >70mm i/o; sig RV dyfx/dilatation, sig tricuspid leaflet tethering, afib, pulm htn, hx of rheumatic mitral disease, hx of RH failure

-rec’d for mild/mod TR at time of left side surgery + Tricuspid annular dilatation or RH failure