Evidence-based surgical management of acquired tricuspid valve disease

Tricuspid valve (TV) disease most often occurs secondary to left-sided heart disease, particularly mitral valve (MV) regurgitation or stenosis. Appropriate treatment, even when TV regurgitation is secondary to left-sided heart disease, can improve long-term outcome. Valvuloplasty is the most common procedure for TV disease, and has received an increasing amount of attention, as right-sided heart failure combined with TV regurgitation is associated with poor long-term outcome. Although some controversies exist regarding the indication and timing of the TV operation, concomitant surgical repair of TV regurgitation at the time of MV surgery should be considered, as this procedure improves perioperative outcomes, functional class, and survival. Importantly, TV repair does not increase operative mortality. In our experience, both suture annuloplasty and partial ring annuloplasty give satisfactory results, and bioprosthetic valves can be used when leaflets are damaged and the TV annulus is extremely dilated.