If possible, valve repair is preferable to valve replacement. Ring annuloplasty, preferably with prosthetic rings, is key to surgery for secondary tricuspid regurgitation.^156,161 Valve replacement should be considered when the tricuspid valve leaflets are significantly tethered and the annulus is severely dilated. In the presence of transtricuspid pacemaker leads, the technique used should be adapted to the patient’s condition and the surgeon’s experience. Percutaneous repair techniques are in their infancy and must be further evaluated before any recommendations can be made.

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Indications for tricuspid valve surgery

2D = two-dimensional; LV = left ventricular; PMC = percutaneous mitral commissurotomy; RV = right ventricular.

a

Class of recommendation.

b

Level of evidence.

c

Percutaneous balloon valvuloplasty can be attempted as a first approach if tricuspid stenosis is isolated.

d

Percutaneous balloon valvuloplasty can be attempted if PMC can be performed on the mitral valve.

Open in new tab

Indications for tricuspid valve surgery

2D = two-dimensional; LV = left ventricular; PMC = percutaneous mitral commissurotomy; RV = right ventricular.

a

Class of recommendation.

b

Level of evidence.

c

Percutaneous balloon valvuloplasty can be attempted as a first approach if tricuspid stenosis is isolated.

d

Percutaneous balloon valvuloplasty can be attempted if PMC can be performed on the mitral valve.