The Structural Heart and Valve Disease team treats many patients with tricuspid valve disease. They have years of experience and are able to offer multiple therapies and procedures, including:
The Structural Heart and Valve Disease team will talk with you about these treatment options to determine the best approach for your specific needs.
Transcatheter Tricuspid Valve Repair
Many individuals with advanced tricuspid regurgitation cannot have open-heart surgery because of their age, or because they are too frail, too sick or they have multiple medical conditions. If you have significant tricuspid valve regurgitation, but you cannot have surgery, your heart team may consider transcatheter tricuspid valve repair.
Although transcatheter valve repair has been done for quite a while with other heart valves, it is a relatively new procedure for the tricuspid valve. In fact, cardiologists with the Swedish Structural Heart and Valve Disease Program were the first on the West Coast to perform a transcatheter tricuspid valve repair.
Your physician will use 3-D imaging to analyze and evaluate the tricuspid valve in very fine detail before, during and after the procedure.
3-dimensional transesophageal echocardiogram evaluation of clip orientation above the tricuspid valve (dashed line). The letters S,A,P denote the tricuspid valve Septal leaflet, Anterior leaflet, and Posterior leaflet, respectively.
Your doctor will make a small incision in your groin and thread a tiny catheter through a vein to your heart. This catheter is used to deliver the MitraClip, which is a small device that clips the leaflets together to reduce the backward flow of blood.
Before and after pictures of the tricuspid regurgitation.
In most cases, the anesthesiologist uses twilight anesthesia (conscious sedation). This avoids the need for a breathing tube and makes it possible for you to move around sooner after the procedure.
Following the procedure, you will stay overnight in the hospital for a couple of days for monitoring and then recover at home.
Transcatheter Tricuspid Valve-in-Valve or Valve-in-Ring Replacement
Transcatheter tricuspid valve-in-valve replacement is a therapy for patients who have had a previous valve replacement procedure using a bioprosthetic valve, but the valve is no longer working properly. Bioprosthetic valves are made from animal valves or tissue, and usually last 10-20 years. That is why younger patients who have had a tricuspid valve replacement using a bioprosthetic valve may need to have it replaced at some point.
Depending on the tricuspid valve, this procedure may be done with general anesthesia or conscious (twilight) sedation. The new valve is implanted through a catheter that the doctor threads through a small incision in the groin and into the heart. Once the doctor sees that it is positioned correctly, a small balloon inflates to push the valve open. As soon as the new valve is open, it takes over responsibility for controlling the blood flow. Typically patients stay in the hospital for one to three days after their procedure.
Transcatheter Balloon Tricuspid Valvuloplasty
Balloon tricuspid valvuloplasty is a procedure to widen the opening in a valve that has narrowed due to tricuspid valve stenosis. Typically it is a procedure that is used in place of valve replacement in children, teens and young adults who have congenital stenosis. It may also be used as a “bridge” for older adults who are too sick to have a valve replacement procedure right away. In older adults who have had balloon valvuloplasty the stenosis may return, which would then require a valve replacement procedure.
You may be awake, but your anesthesiologist will administer local anesthesia and other pain medicine to minimize pain and to ensure you are relaxed and not anxious. Your cardiologist will insert a catheter through a very small incision in your groin, and will thread it through the artery into your heart and valve. After ensuring proper placement, your cardiologist inflates the balloon at the end of the catheter. Patients usually stay in the hospital one day after their balloon procedure.
Open Repair or Replacement Surgery
Open-heart surgery is the most common treatment to repair or replace a damaged tricuspid valve in young and healthy adults. Surgeons will try to repair your valve whenever possible. You will be under general anesthesia. Your heart surgeon will make a long incision (six to eight inches) in your chest and through your breast bone to allow access to the heart. Throughout the entire procedure your blood will circulate through a cardiopulmonary bypass (heart-lung) machine (keeps blood circulating through your body, but diverts it around the valve that is being replaced. The pump is often called a heart-lung machine.) If your valve is very damaged, your surgeon will replace it with a mechanical valve (an artificial valve used to replace a damaged heart valve, usually made out of titanium or carbon) or a bioprosthetic valve (an artificial heart valve made out of animal tissue, usually from a pig), rather than trying to repair it.
After surgery, you will recover in the hospital for a few days and then at home for several weeks or possibly a couple of months.
Elderly individuals and those who are very frail or have multiple medical conditions may not be eligible for open-heart surgery.
For more information about open-heart tricuspid valve surgery, go to Swedish Cardiac Surgery >
Minimally Invasive Tricuspid Valve Repair or Replacement
The Swedish team of heart surgeons is also able to repair or replace tricuspid valves using a minimally invasive approach. Your heart surgeon may choose to repair or replace the tricuspid valve using a procedure called a mini-sternotomy. It is similar to open-heart surgery, except the heart surgeon makes only a four- or five-inch incision in the upper part of the chest and only spreads the upper portion of the breast bone. In some cases, the incision can be even smaller, which helps speed up healing.
Another surgical option is a mini-thoracotomy, which doesn’t require cutting through the breast bone. Instead, the surgeon makes a two-to-three inch incision and uses special instruments to access the heart through the ribs.
Surveillance and Medical Management
Tricuspid valve stenosis and tricuspid valve regurgitation can develop over time. Therefore, you may have mild or no symptoms at all. At first, your doctor may want to monitor your condition during regular visits and may prescribe medicine to help control your symptoms. For example, you may take medicine to reduce fluid build-up, lower your blood pressure, slow your heart rate and/or control your heart’s rhythm. During this time, your doctor may also order repeat echocardiograms to track the progress of your tricuspid valve disease.
Eventually, as your symptoms worsen and they begin to affect your quality of life, your doctor may recommend surgery to repair or replace the damaged valve. If your heart is enlarging too much, your doctor may recommend surgery even though you don’t have symptoms.
For more information about minimally invasive surgery for tricuspid valve repair or replacement, go to Swedish Cardiac Surgery >
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