What you can expect
During the procedure
For most tricuspid valve repair and tricuspid valve replacement procedures, you'll receive anesthetics so you won't feel any pain, and you'll be unconscious during the surgery.
You'll also be connected to a heart-lung bypass machine, which keeps blood moving through your body during the procedure.
Tricuspid valve repair
Tricuspid valve repair is traditionally done with open-heart surgery and opening of the chest bone (sternotomy). Doctors wire the bone back together after the procedure to prevent movement and aid in healing.
Tricuspid valve repair procedures may involve several different types of repair, including:
- Inserting tissue to patch holes or tears in the flaps (perforated leaflets) that close off the valve
- Adding support at the base or roots of the valve
- Separating fused valve leaflets
- Reshaping or removing tissue to allow the valve to close more tightly
- Tightening or reinforcing the ring around a valve (annulus) by implanting an artificial ring (annuloplasty)
Cone tricuspid valve repair
A newer type of tricuspid valve repair is known as the cone procedure. The procedure is done to repair leaky tricuspid valves in people with Ebstein anomaly.
In this procedure, surgeons separate the flaps (leaflets) that close off the tricuspid valve from the underlying heart muscle. The leaflets are rotated and reattached to create a circle of leaflet tissue also known as a leaflet cone.
Minimally invasive tricuspid valve repair
Tricuspid valves that can't open fully due to tricuspid valve stenosis may be repaired with surgery or with a less invasive procedure called balloon valvuloplasty or valvotomy. But these procedures are rarely performed because tricuspid stenosis is uncommon.
During the procedure, your doctor inserts a thin, hollow tube (catheter) in a blood vessel, usually in your groin, and threads it to your heart. The catheter has a balloon at its tip that can be inflated to help widen the narrowed tricuspid valve and then deflated for removal.
You're usually sedated but awake during the procedure. Minimally invasive tricuspid valve repair requires a much shorter hospital stay than traditional heart surgery.
Balloon valvuloplasty is often used to treat infants and children with tricuspid valve stenosis. However, the valve tends to narrow again in adults who have had the procedure, so it's usually only performed in adults who are too ill for surgery or who are waiting for a valve replacement. You may need additional procedures to treat the narrowed valve over time.
Tricuspid valve replacement
In this procedure, your doctor replaces the tricuspid valve with a mechanical valve or, much more commonly, a tissue valve made from cow or pig heart tissue (biological tissue valve)
Biological tissue valves eventually need to be replaced, as they degenerate over time. Biological valves require short-term use of blood-thinning medicines for about three to six months. These medications can usually be discontinued at that time unless there is another medical reason to continue use, such as irregular heartbeats.
If you have a mechanical valve, you'll need to take blood-thinning medications for the rest of your life to prevent blood clots or valve thrombosis. Doctors will discuss with you the risks and benefits of each type of valve and discuss which valve may be most appropriate for you.
Tricuspid valve replacement surgery may be done using traditional open-heart surgery or minimally invasive methods, which involve smaller incisions than those used in open-heart surgery and may include robot-assisted techniques.
A minimally invasive valve-in-valve procedure may also be used to replace an existing replacement tricuspid valve that's failing. In this procedure, a thin plastic tube (catheter) is inserted in a large artery, usually in the groin, and threaded to the heart. Once in place, a new replacement valve is inserted within the existing valve.
Minimally invasive tricuspid valve replacement may be considered if no other heart procedures are necessary and the surgeon and medical center have appropriate skill and expertise. When performed by experienced surgeons and centers, the results are similar to those with traditional open-heart surgery.
After the procedure
You'll generally spend a day or more in the intensive care unit (ICU). You'll be given fluids and medications through intravenous (IV) lines. Other tubes will drain urine from your bladder and drain fluid and blood from your heart and chest. You may be given oxygen.
After the ICU, you'll be moved to a regular hospital room for several days. The time you spend in the ICU and hospital can vary, depending on your condition and procedure.
During your hospital stay, your treatment team will:
- Watch for signs of infection in your incision sites
- Periodically check your blood pressure, breathing and heart rate
- Work with you to manage any pain you experience after surgery
- Instruct you to walk regularly to gradually increase your activity and do breathing exercises as you recover
Your doctor may give you instructions to follow during your recovery, such as watching for signs of infection in your incisions, properly caring for incisions, taking medications, and managing pain and other side effects after your surgery.
Recovery time depends on your procedure, overall health before the procedure and any complications.