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Functional tricuspid regurgitation: indications, techniques, and outcomes
Tessa M F Watt1, Alexander A Brescia1, Aaron M Williams1
1Department of Cardiac Surgery, University of Michigan, Frankel Cardiovascular Center, 1500 East Medical Center Drive, Ann Arbor, MI 48109 USA.
Indian Journal of Thoracic and Cardiovascular Surgery
|October 16, 2020
Summary
Functional tricuspid regurgitation (TR) stems from enlarged heart chambers. Surgical repair, including rigid rings and new minimally invasive methods, offers better outcomes for this under-treated condition.
Area of Science:
- Cardiovascular Medicine
- Cardiac Surgery
- Interventional Cardiology
Background:
- Functional tricuspid regurgitation (TR) arises from tricuspid annular dilation, often secondary to left heart disease impacting the right ventricle.
- Postoperative worsening of TR after left-sided valvular surgery is common and associated with poor prognosis.
- Despite evidence of adverse outcomes, surgical intervention for functional TR is frequently underutilized.
Purpose of the Study:
- To review current understanding of functional tricuspid regurgitation.
- To discuss the implications of TR in patients undergoing left-sided valvular surgery.
- To highlight surgical and emerging interventional treatment options for functional TR.
Main Methods:
- Review of existing literature on functional tricuspid regurgitation.
- Analysis of surgical repair techniques for tricuspid annular dilation.
- Evaluation of percutaneous annuloplasty as an emerging treatment modality.
Main Results:
- Rigid or semi-rigid tricuspid annular ring placement demonstrates superior longevity compared to suture or flexible band repairs.
- Percutaneous annuloplasty techniques are emerging as viable options for patients with high surgical risk.
- Underutilization of TR surgery persists despite known poor outcomes associated with residual TR.
Conclusions:
- Functional TR requires careful consideration, especially in patients undergoing left-sided valve surgery.
- Surgical repair with rigid annuloplasty rings offers durable results.
- Percutaneous techniques represent a promising advancement for treating functional TR, expanding treatment accessibility.
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