The role of tricuspid valve repair and replacement in right heart failure

PURPOSE OF REVIEW: The presence of tricuspid regurgitation in the setting of right ventricular dysfunction is associated with poor prognosis. The purpose of this review is to describe the pathophysiology of functional tricuspid regurgitation, summarize the current reports favoring a more aggressive approach toward tricuspid valve surgery, and discuss the emerging role of tricuspid valve annuloplasty with left ventricular assist device (LVAD) implantation. RECENT FINDINGS: The rationale for offering tricuspid valve surgery is based upon an understanding of the natural history of functional tricuspid regurgitation in the setting of left heart disease. In this regard, several observations have been made. First, tricuspid regurgitation does not simply go away after correction of left-sided lesions. Second, functional tricuspid regurgitation is a progressive disorder characterized by a spiral of right ventricular chamber enlargement leading to further annular dilatation and more tricuspid regurgitation. Finally, operative mortality for isolated tricuspid valve surgery, particularly re-operative surgery, is quite high and is influenced by right ventricular function. SUMMARY: The presence of significant tricuspid regurgitation, whether in the context of mitral valve disease or heart failure, should no longer be treated with 'surgical abstention'. Whether the surgical correction of tricuspid regurgitation in left heart disease can definitively improve clinical outcomes should be addressed by prospective clinical trials.