Beyond Annuloplasty: Anatomy-based Tricuspid Valve Repair for Right Ventricular Dysfunction

Area of Science:

• Cardiovascular Surgery
• Valvular Heart Disease
• Cardiac Anatomy

Background:

• Functional tricuspid regurgitation (FTR) with right ventricular (RV) remodelling presents complex surgical challenges.
• Limited standardized training exists for advanced tricuspid valve reconstruction techniques.
• Existing surgical approaches often focus primarily on annuloplasty, leaving a gap in comprehensive management.

Purpose of the Study:

• To consolidate and structure the evolving knowledge base of surgical tricuspid valve repair.
• To provide a comprehensive reference for techniques beyond simple annuloplasty.
• To guide surgeons in managing complex tricuspid valve disease associated with RV remodelling.

Main Methods:

• A targeted literature review identified key reports on surgical tricuspid valve interventions.
• Narrative synthesis outlined principles, indications, and anatomical rationale for various repair techniques.
• Techniques reviewed include edge-to-edge repair, leaflet augmentation, papillary muscle relocation, and others.

Main Results:

• A diverse range of surgical techniques exists for tricuspid valve repair, addressing leaflet geometry and subvalvular alignment.
• These advanced methods aim to restore functional competence in the setting of RV dilatation.
• Understanding the intricate relationship between annular, leaflet, and subvalvular structures is crucial for successful repair.

Conclusions:

• This review unifies scattered concepts into a practical framework for anatomy-guided tricuspid reconstruction.
• It offers surgeons an accessible reference for managing complex, RV-dependent tricuspid valve disease.
• The presented strategies aim to achieve functional and durable repairs, potentially rivaling transcatheter options.