Tricuspid stenosis surgery

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2] ;Mohammed Salih, M.D.; Syed Musadiq Ali M.B.B.S.[3] Rim Halaby, M.D. [4]

Overview

Surgical tricuspid valve replacement in tricuspid stenosis (TS) is recommended among patients undergoing surgical intervention for left valvular disease as well as among patients with severe symptomatic isolated tricuspid stenosis (TS).

Surgery

Recommendations for intervention in tricuspid valve disease
Tricuspid stenosis (Class I, Level of Evidence C):
❑ Surgery is recommended in symptomatic patients with severe tricuspid stenosis ❑ Surgery is recommended in patients with severe tricuspid stenosis undergoing left-sided valve intervention

The above table adopted from 2021 ESC Guideline^[1]

Surgery is the mainstay of treatment for tricuspid stenosis (TS), which includes the following:^[2]^[3]

Valvotomy

Valvotomy in tricuspid stenosis (TS) patients is done by using 1, 2, or 3 balloons.^[4]^[5]^[6]^[7]^[8]
By undergoing balloon valvotomy the tricuspid valve area increase from less than 1 to almost 2 cm2.
In cases of severe rheumatic tricuspid stenosis using a inoue balloon is much more useful and a simplified approach.^[9]
With valvotomy there is significant change in transvalvular pressure gradient across tricuspid valve and there is a decrease in right atrial pressure.

Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis. Case courtesy by Emmanouil Petrou, MD et al^[10]

Valve surgery

In tricuspid stenosis (TS) patients valve surgery include either valve repair or valve replacement.^[11]^[12]^[13]
Consider repair of the tricuspid valve if its feasible.
If tricuspid valve repair not an option consider valve replacement.
Patients who are undergoing tricuspid valve replacement the mortality rate is little higher when compared to patients who are undergoing tricuspid valve repair.
While considering tricuspid valve replacement it can be done in 2 ways:
- Open tricuspid valve replacement
- Transcatheter replacement

Surgeon can choose either a bioprosthetic valve or an mechanical valve, the outcome is same using either of the valves with some conditions as an exception.
Survival in patients with bioprosthetic valve or an mechanical valve is almost the same.
In patients with carcinoid syndrome, using a mechanical valve over a bioprosthetic valve is better choice to avoid the degeneration on the valve.

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary^[2]

Class I
"1. Tricuspid valve surgery is recommended for patients with severe TS at the time of operation for left-sided valve disease. (Level of Evidence: C)"
"2. Tricuspid valve surgery is recommended for patients with isolated, symptomatic severe TS. (Level of Evidence: C)"

Class IIb
"1. Percutaneous balloon tricuspid commissurotomy might be considered in patients with isolated, symptomatic severe TS without accompanying TR. (Level of Evidence: C)"

References

↑ Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W (February 2022). "2021 ESC/EACTS Guidelines for the management of valvular heart disease". Eur Heart J. 43 (7): 561–632. doi:10.1093/eurheartj/ehab395. PMID 34453165 Check |pmid= value (help).
↑ ^2.0 ^2.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.
↑ Yunoki, Kei; Naruko, Takahiko; Itoh, Akira; Ohashi, Junko; Fujimoto, Kohei; Shirai, Naoya; Shimamura, Koichi; Komatsu, Ryushi; Sakanoue, Yuji; Haze, Kazuo (2006). "Percutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis". Circulation. 114 (18). doi:10.1161/CIRCULATIONAHA.106.618611. ISSN 0009-7322.
↑ Orbe, Luis Calvo; Sobrino, Nicolas; Arcas, Ramón; Peinado, Rafael; Frutos, Araceli; Blazquez, Jose Rico; Maté, Isabel; Sobrino, Jose Antonio (1993). "Initial outcome of percutaneous balloon valvuloplasty in rheumatic tricuspid valve stenosis". The American Journal of Cardiology. 71 (4): 353–354. doi:10.1016/0002-9149(93)90808-P. ISSN 0002-9149.
↑ Rana G, Malhotra R, Sharma A, Kakouros N (2017). "Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis". Tex Heart Inst J. 44 (1): 43–49. doi:10.14503/THIJ-15-5408. PMC 5317359. PMID 28265212.
↑ Sobrino N, Calvo Orbe L, Merino JL, Peinado R, Mate I, Rico J; et al. (1995). "Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis". Eur Heart J. 16 (5): 711–3. doi:10.1093/oxfordjournals.eurheartj.a060979. PMID 7588907.
↑ Ribeiro, Paulo A.; Zaibag, Muayed Al; Kasab, Saad Al; Idris, Mohamed; Halim, Murtada; Abdullah, Moheeb; Shahed, Maie (1988). "Percutaneous double balloon valvotomy for rheumatic tricuspid stenosis". The American Journal of Cardiology. 61 (8): 660–662. doi:10.1016/0002-9149(88)90790-4. ISSN 0002-9149.
↑ Egred, M.; Albouaini, K.; Morrison, W.L. (2006). "Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve". Circulation. 113 (18). doi:10.1161/CIRCULATIONAHA.105.568238. ISSN 0009-7322.
↑ Patel TM, Dani SI, Shah SC, Patel TK (1996). "Tricuspid balloon valvuloplasty: a more simplified approach using inoue balloon". Cathet Cardiovasc Diagn. 37 (1): 86–8. doi:10.1002/(SICI)1097-0304(199601)37:1<86::AID-CCD23>3.0.CO;2-T. PMID 8770490.
↑ "Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis".
↑ "StatPearls". 2020. PMID 29763166.
↑ Kunadian B, Vijayalakshmi K, Balasubramanian S, Dunning J (2007). "Should the tricuspid valve be replaced with a mechanical or biological valve?". Interact Cardiovasc Thorac Surg. 6 (4): 551–7. doi:10.1510/icvts.2007.159277. PMID 17669933.
↑ Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S (2012). "Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database". J Thorac Cardiovasc Surg. 143 (5): 1043–9. doi:10.1016/j.jtcvs.2011.07.004. PMID 21872283.

[pmid34453165-1] Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W (February 2022). "2021 ESC/EACTS Guidelines for the management of valvular heart disease". Eur Heart J. 43 (7): 561–632. doi:10.1093/eurheartj/ehab395. PMID 34453165 Check |pmid= value (help).

[pmid24589852-2] 2.0 ^2.1 Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA; et al. (2014). "2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. doi:10.1161/CIR.0000000000000029. PMID 24589852.

[YunokiNaruko2006-3] Yunoki, Kei; Naruko, Takahiko; Itoh, Akira; Ohashi, Junko; Fujimoto, Kohei; Shirai, Naoya; Shimamura, Koichi; Komatsu, Ryushi; Sakanoue, Yuji; Haze, Kazuo (2006). "Percutaneous Transcatheter Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis". Circulation. 114 (18). doi:10.1161/CIRCULATIONAHA.106.618611. ISSN 0009-7322.

[OrbeSobrino1993-4] Orbe, Luis Calvo; Sobrino, Nicolas; Arcas, Ramón; Peinado, Rafael; Frutos, Araceli; Blazquez, Jose Rico; Maté, Isabel; Sobrino, Jose Antonio (1993). "Initial outcome of percutaneous balloon valvuloplasty in rheumatic tricuspid valve stenosis". The American Journal of Cardiology. 71 (4): 353–354. doi:10.1016/0002-9149(93)90808-P. ISSN 0002-9149.

[pmid28265212-5] Rana G, Malhotra R, Sharma A, Kakouros N (2017). "Percutaneous Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis". Tex Heart Inst J. 44 (1): 43–49. doi:10.14503/THIJ-15-5408. PMC 5317359. PMID 28265212.

[pmid7588907-6] Sobrino N, Calvo Orbe L, Merino JL, Peinado R, Mate I, Rico J; et al. (1995). "Percutaneous balloon valvuloplasty for concurrent mitral, aortic and tricuspid rheumatic stenosis". Eur Heart J. 16 (5): 711–3. doi:10.1093/oxfordjournals.eurheartj.a060979. PMID 7588907.

[RibeiroZaibag1988-7] Ribeiro, Paulo A.; Zaibag, Muayed Al; Kasab, Saad Al; Idris, Mohamed; Halim, Murtada; Abdullah, Moheeb; Shahed, Maie (1988). "Percutaneous double balloon valvotomy for rheumatic tricuspid stenosis". The American Journal of Cardiology. 61 (8): 660–662. doi:10.1016/0002-9149(88)90790-4. ISSN 0002-9149.

[EgredAlbouaini2006-8] Egred, M.; Albouaini, K.; Morrison, W.L. (2006). "Balloon Valvuloplasty of a Stenosed Bioprosthetic Tricuspid Valve". Circulation. 113 (18). doi:10.1161/CIRCULATIONAHA.105.568238. ISSN 0009-7322.

[pmid8770490-9] Patel TM, Dani SI, Shah SC, Patel TK (1996). "Tricuspid balloon valvuloplasty: a more simplified approach using inoue balloon". Cathet Cardiovasc Diagn. 37 (1): 86–8. doi:10.1002/(SICI)1097-0304(199601)37:1<86::AID-CCD23>3.0.CO;2-T. PMID 8770490.

[10] "Balloon Valvuloplasty for Bioprosthetic Tricuspid Valve Stenosis".

[pmid29763166-11] "StatPearls". 2020. PMID 29763166.

[pmid17669933-12] Kunadian B, Vijayalakshmi K, Balasubramanian S, Dunning J (2007). "Should the tricuspid valve be replaced with a mechanical or biological valve?". Interact Cardiovasc Thorac Surg. 6 (4): 551–7. doi:10.1510/icvts.2007.159277. PMID 17669933.

[pmid21872283-13] Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S (2012). "Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database". J Thorac Cardiovasc Surg. 143 (5): 1043–9. doi:10.1016/j.jtcvs.2011.07.004. PMID 21872283.

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Tricuspid stenosis surgery

Overview

Surgery

2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary[2]

References

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2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary^[2]