Tricuspid Valve Surgery
What is tricuspid valve surgery?
Tricuspid valve surgery repairs or replaces the tricuspid heart valve. Heart valves keep blood flowing in the right direction. Blood enters the heart in the right atrium, moves down to the right ventricle, pumps out to the lungs, re-enters in the left atrium, flows down to the left ventricle, and pumps out to the body. Four heart valves control this movement. The tricuspid valve sits between the right atrium (upper chamber) and the right ventricle (lower chamber).
The tricuspid valve has three flaps or leaflets. They open to let blood flow forward to the right ventricle and close tightly to stop blood from leaking backwards. A diseased or damaged tricuspid valve cannot regulate this flow the way it should. Tricuspid valve surgery can restore proper tricuspid valve function.
There are two main kinds of tricuspid valve surgery:
- Tricuspid valve repair mends a diseased or damaged tricuspid valve. There are several different repair surgeries, depending on the specific valve problem. Doctors can widen the valve opening (balloon valvuloplasty), tighten the valve opening (ring annuloplasty), fix holes or tears in a flap (leaflet patching), or separate or reshape the flaps (commissurotomy, decalcification and resection).
- Tricuspid valve replacement takes out a diseased or damaged tricuspid valve and replaces it with a new valve. New valves are either man-made mechanical valves or biological tissue valves. Biological valves can come from humans, pigs or cows. They are more common than mechanical valves.
Tricuspid valve disease is much less common than other types of heart valve disease. As a result, tricuspid valve surgery is also less common than other heart valve surgeries.
Why is tricuspid valve surgery performed?
Doctors may recommend tricuspid valve surgery when the valve is diseased or damaged. The two main types of tricuspid valve disease include:
- Tricuspid valve regurgitation happens when the valve does not close tightly enough. Blood can leak back through the valve into the right atrium when the right ventricle contracts instead of flowing out to the lungs. In most cases, the cause is heart or lung disease that causes the right ventricle to enlarge. This pulls the tricuspid valve flaps apart.
- Tricuspid valve stenosis is a narrowing of the valve. The valve cannot fully open, which prevents blood from flowing into the right ventricle effectively. Tricuspid valve stenosis is less common than regurgitation. It is most often the result of damage from rheumatic heart disease—a complication of strep infections.
Most tricuspid valve disease occurs with other heart problems. So, most tricuspid valve surgeries take place along with other heart surgeries, including other valve surgeries. It is uncommon to have tricuspid valve surgery alone. However, if symptoms of tricuspid heart valve disease become severe, your doctor may discuss surgery with you. Symptoms can include fatigue, shortness of breath, weakness, swelling, and a pulsing sensation in the neck.
If medications are failing to control symptoms of tricuspid valve disease, valve repair is often the preferred surgery. Repairs generally have a lower risk of infection and better overall results. However, not all valves can be repaired and replacement may be necessary instead. Talk with your doctor about all risks and benefits of surgery and ask if you are a candidate for a minimally invasive procedure.
Who performs tricuspid valve surgery?
Cardiac surgeons and interventional cardiologists perform tricuspid valve surgeries. Cardiac surgeons specialize in the surgical treatment of conditions affecting the heart and its blood vessels. Other names for cardiac surgeons include heart surgeons, cardiothoracic surgeons, and cardiovascular surgeons.
An interventional cardiologist is an expert in diagnosing and treating conditions and diseases of the heart and blood vessels. This specialist uses nonsurgical, catheter-based procedures, and specialized imaging techniques.
How is the tricuspid valve surgery performed?
Tricuspid valve surgery takes place in a hospital using general anesthesia. General anesthesia consists of a combination of IV (intravenous) medicines and gases that put you in a deep sleep. You are not aware of the procedure and do not feel pain.
There are several surgical options for tricuspid valve surgery:
- Catheter-based surgery may be an option for some people. Catheter surgery involves inserting a thin, flexible catheter through a blood vessel in your groin. The surgeon threads the catheter up to the heart until it reaches the tricuspid valve. The surgeon uses specialized instruments in the catheter tip to perform the repair or replacement. This type of surgery may only be available at certain medical centers.
- Minimally invasive surgery includes a few different techniques. It may involve a small 2- to 3-inch incision in your chest or several smaller incisions for endoscopic surgery. An endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures to a computer screen your doctor uses to perform the surgery. Minimally invasive surgery causes less trauma to tissues. So, it generally has a shorter recovery time, fewer complications, and less pain than open surgical procedures.
- Robot-assisted surgery is a type of minimally invasive surgery. The robot provides magnified 3D images and uses tiny tools with much greater flexibility and dexterity than a human hand. This allows your surgeon to operate with more precision and control. This type of surgery may only be available at certain medical centers.
- Open surgery involves a 6- to 8-inch incision in your chest and cutting through the breast bone. This allows your surgeon to directly view and access the heart. With open heart surgery, it generally takes longer to recover and has a higher risk of complications and more pain than minimally invasive surgery. Despite this, open heart surgery may be a safer or more effective method for certain patients.
The choice of technique depends on the specific procedure you need and whether or not you are having another heart procedure at the same time.
Talk with your doctor about all your surgical options. Consider getting a second opinion before making a final choice. Second opinions are valuable because they give you information. The consulting doctor may reinforce what you have already heard or give you new insights into your situation. Either way, a second opinion can help you feel more confident about your decision.
What to expect the day of your surgery
In some cases, you may already be in the hospital before tricuspid valve surgery. If not, this is generally what happens the day of your surgery:
- You will change into a hospital gown and remove all jewelry. It is best to leave valuables at home or with a family member.
- You will talk with a preoperative nurse, who may perform a brief exam.
- You will talk with the anesthesiologist about your medical history and the type of anesthesia you will receive.
- A team member will start an IV and you may get a sedative to help you relax.
- Once you are in the operating room, the anesthesiologist will start general anesthesia. You won’t remember anything else until you wake up in the recovery room.
- Your surgery may involve cardiopulmonary bypass using a heart-lung machine. If so, it will temporarily take over the job of pumping oxygen-rich blood to your organs and tissues. This allows your surgeon to operate on a heart that is not beating and has no blood traveling through it.
- Your team will monitor and support your vital body functions throughout the procedure and during recovery.
What are the risks and potential complications of tricuspid valve surgery?
All surgeries, especially heart surgeries, involve risk and the possibility of complications. Problems can occur during the procedure itself or develop during recovery. In some cases, complications can be serious and even life-threatening. Your own risk of complications depends on your overall health, the specific procedure, and the expertise and experience of your surgical team.
General risks of surgery
The general risks of surgery include:
- Anesthesia reaction, such as an allergic reaction and problems with breathing
- Bleeding, which can lead to shock
- Blood clot, in particular a deep vein thrombosis (DVT) that develops in the leg or pelvis. A DVT can travel to your lungs and cause a pulmonary embolism.
Potential complications of tricuspid valve surgery
Most tricuspid valve surgeries are successful, but potential complications include:
- Heart arrhythmias
- Memory problems
- Post-pericardiotomy syndrome, which is a low-grade fever and chest pain for up to six months after open heart surgery
- Valve infection or malfunction in valve replacements
Reducing your risk of complications
You can reduce your risk of certain complications by:
- Following activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery
- Informing your doctor if you are nursing or if there is any possibility of pregnancy
- Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
- Taking your medications exactly as directed
- Telling all members of your care team if you have allergies
How do I prepare for a tricuspid valve surgery?
You can help improve your comfort and outcome after surgery by taking the following steps:
- Answering all questions about your medical history and medications. This includes prescription medications, over-the-counter drugs, herbal supplements, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
- Losing weight if you are overweight through a healthy diet and safe exercise plan.
- Not eating or drinking before surgery as directed. This reduces the risk of complications, such as choking on stomach contents during deep anesthesia. You may have to reschedule surgery if you eat or drink too close to the start of the procedure.
- Stop smoking as soon as possible. Even quitting for just a few days can help prevent complications from poor healing that can occur with smoking.
- Taking or stopping medications exactly as directed. For tricuspid valve surgery, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
There is a lot to remember when you are thinking about tricuspid valve surgery. Consider making a list of questions to help you remember everything you want to ask your doctor. Questions you may have include:
- Why are you recommending tricuspid valve surgery? Are there any other treatment options I can try first?
- What type of tricuspid valve surgery are you recommending and why?
- Will you combine my tricuspid valve surgery with another heart surgery?
- How long will the surgery take? When will I be able to go home?
- What restrictions will I have after the surgery? When can I expect to return to work and other activities?
- What kind of assistance will I need at home?
- What medication plan should I follow before and after the surgery? How do I take my usual medications?
- Will I need cardiac rehab after surgery? If so, how long will I need it?
- How should I contact you? When should I see you in follow-up? Ask for numbers to call during and after regular hours.
What can I expect after tricuspid valve surgery?
It is easier to plan and prepare for tricuspid valve surgery recovery when you know what to expect.
How long will it take to recover?
After surgery, you will likely spend a day or more in an ICU (intensive care unit). As you recover, you will move to a regular hospital room outside the ICU. The length of time you spend in the ICU and hospital will depend on the specific procedure you had. An average hospital stay is about 5 days and can range from 3 to 7 days.
Recovery after heart surgery is gradual. Many variables can influence how long it takes you to return to normal activities. This includes factors like your age, the specific procedure, and your general health.
After heart surgery, cardiac rehabilitation can help you recover safely and more quickly. Cardiac rehab is a medically supervised program that usually lasts about 3 months. Full tricuspid valve surgery recovery can take 3 to 4 months.
Will I feel pain?
You will be in pain after tricuspid valve surgery. Controlling pain is important for healing and a smooth recovery. It allows you to fully participate in your rehabilitation. Take your pain medicine on schedule, and before you feel an increase in pain. Contact your doctor if you are in pain despite following your pain control plan or if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
For questions between appointments, contact your doctor’s office. However, you should call your doctor right away or seek immediate medical care if you have any of the following:
- Breathing problems or shortness of breath
- Chest pain, pressure or tightness
- Confusion or changes in level of alertness
- Drainage of pus, redness or swelling around your incision(s)
- Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
- Inability to urinate or move your bowels
- Leg pain, redness or swelling, which could mean you have a blood clot
- Sudden weight gain, which can be a serious sign that you are retaining fluids
- Unexpected bleeding
How might tricuspid valve surgery affect my everyday life?
Tricuspid valve surgery may relieve your symptoms and improve your heart function. However, surgery won’t prevent heart disease problems in the future. There are steps you can take to prevent or delay recurrence of heart disease including:
- Eating a heart-healthy diet
- Getting regular exercise
- Maintaining a healthy weight
- Practicing stress management techniques
- Quitting smoking
For tricuspid valve replacement using a tissue valve, you will need to take anticoagulant medicine for a period of time. Usually, it is about 3 to 6 months. These valves last about 15 to 20 years. Mechanical valves can last longer, but require lifelong anticoagulant therapy. Tricuspid valve repairs have no need for anticoagulation. About 95% of people who have a tricuspid valve repair do not need another intervention for 10 to 20 years.