Tricuspid Valve Repair Surgery
What is tricuspid valve repair?
The heart has 4 valves. These valves are made of flaps that work together to open
and close. This helps blood flow through the heart and out to the body. The valves
promote forward flow and prevent backflow. The tricuspid valve lies between the right
atrium (right upper chamber) and the right ventricle (right lower chamber).
When the flaps don’t close properly, blood leaks back into a chamber of the heart
instead of moving forward. This condition is called tricuspid regurgitation (TR).
When the flaps don’t open enough, blood is forced through too small an opening. This
condition is called tricuspid stenosis. This condition is rare. It typically occurs
with other valve abnormalities.
Causes of tricuspid valve problems include birth defects, rheumatic fever, infection,
left ventricular heart failure, pulmonary hypertension, and changes that come with
aging. Surgeons can use several techniques to repair a leaking tricuspid valve. These
include attaching bands to support the valve, inserting rings around the valve base
(annulus), and using specific types of stitches to help the valve flaps work better.
Surgeons may repair the valve with open-heart or minimally-invasive surgery.
Why might I need a tricuspid valve repair?
You may need a tricuspid valve repair if your valve is leaky or doesn't open and close
properly. You may need surgery to correct a birth defect or damage to the valve from
endocarditis, an infection of your heart tissue. When the problem is just with the
tricuspid valve, successful valve repair could help you regain energy and endurance.
However, isolated repair of the tricuspid valve alone is rare. Surgeons usually repair
this valve during another planned heart surgery.
What are the risks of a tricuspid valve repair?
Tricuspid valve repair is major surgery that requires general anesthesia. This means
you will be put to sleep and will not feel pain during the surgery. Any general anesthesia
has the risk of heart or brain injury. Major surgery also carries the risk of blood
clots forming during or after surgery. These clots can break free and travel to your
lungs (causing a pulmonary embolism), to your brain (causing a stroke), or block blood
flow as the clot becomes lodged in other blood vessels.
Other risks of the procedure include:
Bleeding, which may require transfusions
Damage to nearby organs, tissues, or nerves
Infection of the heart (endocarditis)
Reaction to medicine
Irregular heartbeats (arrhythmias)
Heart block, requiring a pacemaker
Inability to repair valve requiring valve replacement
There may be other risks, depending on your specific health condition. Discuss any
concerns with your healthcare provider before the procedure.
How do I get ready for a tricuspid valve repair?
Before tricuspid valve surgery, your healthcare provider will evaluate your medical
condition. Your surgeon will use echocardiogram and cardiac catheterization to find
out how your tricuspid valve is working. These tests also help in planning for your
surgery. An echocardiogram is an ultrasound of the heart to look at the valve and
heart muscle function. Cardiac catheterization is a test done to look at blood flow
through the arteries of the heart muscle and to measure the pressure inside of the
heart and the lungs.
Your healthcare provider will explain the procedure. Talk with your healthcare provider
about any questions you may have.
You will sign a consent form that gives your permission to do the procedure. Read
the form carefully and ask questions if something is not clear.
Your healthcare provider may do a complete physical exam to ensure you are in otherwise
good health before undergoing the procedure. You may have blood tests or other diagnostic
Follow any directions you are given for not eating or drinking before surgery.
You may be asked to shower the night before surgery or the morning of surgery using
an antibacterial scrub to prevent infection of the incision sites.
Tell your healthcare provider right away if you are pregnant or think you could be
Tell your healthcare provider:
If you are sensitive to or are allergic to any medicines, iodine, latex, tape, or
anesthesia (local and general)
About all prescription and over-the-counter medicines, and herbal supplements that
you are taking. You may need to stop taking certain medicines before your surgery.
Follow your healthcare provider's instructions about which medicines need to be stopped
If you have a history of bleeding disorders or if you are taking any blood-thinning
medicines (anticoagulants), aspirin, or other medicines that affect blood clotting.
You may be told to stop some of these medicines before the procedure. Your healthcare
provider may request a blood test before the procedure to determine how long it takes
your blood to clot.
If you have a pacemaker or other implanted cardiac devices
If you smoke, stop smoking as soon as possible before the procedure. This may improve
your chances for a successful recovery from surgery and benefit your overall health
Based on your condition, your healthcare provider may have other instructions for
What happens during a tricuspid valve repair?
Heart valve repair surgery usually requires a stay in a hospital. Procedures may vary
depending on your condition and your surgeon’s practices. Generally, heart valve repair
surgery follows this process:
For open-heart surgery
You will be asked to remove any jewelry or other objects that may interfere with the
You will change into a hospital gown and empty your bladder.
A healthcare professional will start an IV (intravenous) line in your arm or hand.
You may be given IV antibiotics before the procedure starts.
Other catheters may be inserted in your neck and wrist to monitor the status of your
heart and blood pressure, and to take blood samples. Catheters may also be inserted
under the collarbone and the groin.
The anesthesiologist will monitor your heart rate, blood pressure, breathing, and
blood oxygen level during the surgery. Once you are sedated, a breathing tube may
be inserted through your throat into your lungs and you will be connected to a ventilator,
which will breathe for you during the surgery.
A nurse will insert a catheter into your bladder to drain urine.
Your surgeon will insert a transesophageal echocardiogram (TEE) probe into your esophagus
to view the valve function after repair.
A member of the surgical team will clean the skin over the surgical site with an antiseptic
The surgeon will make an incision (cut) down the center of the chest from just below
the Adam's apple to just above the navel.
The doctor will divide the sternum (breastbone) in half lengthwise with a special
operating instrument. The two halves of the breastbone will be separated and spread
apart to expose the heart.
To perform this delicate valve repair, your surgeon will need to stop the heart. Before
stopping the heart, tubes are inserted into the heart so that the blood can be pumped
through your body by a cardiopulmonary bypass machine.
Once the blood has been diverted into the heart-lung bypass machine for pumping, your
surgeon will stop the heart by injecting it with a cold solution.
When the heart has stopped, the repair will begin. The procedure performed will depend
on the type of valve problem you have, for example, separation of fused valve leaflets,
repair of torn leaflets, or the reshaping of valve parts so they work better.
Once the procedure has been completed, your surgeon will allow the blood circulating
through the bypass machine to re-enter your heart. They will shock your heart with
small paddles to restart its electrical activity. Gradually, your heart will resume
pumping blood through your body. Your surgeon will remove the tubes connecting you
to the heart-lung machine.
Once your heart is beating again, the surgeon will check the function of the heart
and the valves.
Your surgeon may insert temporary wires for pacing into your heart. These wires can
be attached to a pacemaker and your heart can be paced, if needed, during the initial
Your surgeon may insert tubes into your chest to drain blood and other fluids from
around the heart. These tubes will be connected to a suction device to drain fluids
away from the heart.
Your surgeon will connect the sternum back together .
Your surgeon will sew the skin over the sternum back together and close it with sutures
A tube may be inserted through your mouth or nose into your stomach to drain stomach
A sterile bandage or dressing will be applied.
For a minimally invasive procedure
If your surgeon performs a l minimally invasive procedure, they will insert special
tools into your chest through several smaller incisions, rather than a single large
incision. These tools will contain a camera, as well as all the instruments needed
to repair your valve. This procedure might take longer than traditional open-heart
surgery but recovery may be easier.
What happens after a tricuspid valve repair?
In the hospital
After the surgery, a member of the surgical team will take you to the recovery room
or the intensive care unit (ICU) to be closely monitored for several days. A nurse
will connect you to monitors that will constantly display your electrocardiogram (ECG)
tracing, blood pressure, other pressure readings, breathing rate, and your oxygen
level. Heart valve repair surgery generally requires a hospital stay of several days
You may have a tube in your throat connected to a breathing machine (ventilator) until
you are stable enough to breathe on your own. As you wake up from the anesthesia more
and start to breathe by yourself, your healthcare provider will adjust the breathing
machine to allow you to take over more of the breathing. When you are awake enough
to breathe completely by yourself and are able to cough, your healthcare provider
will remove the breathing tube. They may also remove the stomach tube at this time.
After the breathing tube is out, your nurse will help you cough and take deep breaths
every couple of hours. This will be uncomfortable due to soreness, but it is very important
that you do this to keep mucus from collecting in your lungs and possibly causing
You will be given pain medicine if you are hurting. Ask for the medicine before you
become extremely uncomfortable. Your nurse will show you how to hug a pillow tightly
against your chest while coughing to help ease the discomfort.
You may get special IV medicines to help your blood pressure and your heart rate and
to control any problems with bleeding. As your condition stabilizes, these medicines
will be gradually decreased and turned off as your condition allows.
Once the breathing and stomach tubes have been removed and your condition has stabilized,
you may start liquids to drink. You can add more solid foods as you can handle them.
When your healthcare provider determines that you are ready, you will be moved from
the ICU to a post-surgical unit or acute care unit. Your recovery will continue to
progress. Your activity will be gradually increased as you get out of bed and walk
around for longer periods.
Arrangements will be made for a follow-up visit with your healthcare provider.
Once your healthcare providers feel that you have recovered, you will be discharged
may go home. Follow all your instructions for medicines, pain control, diet, activity,
and wound care. Your healthcare provider might prescribe blood-thinners to help prevent
blood clots. Make sure you understand how to take them or how these drugs might affect
your health and lifestyle choices. Keep all your follow-up appointments.
Other common instructions after surgery include:
Walk as much as possible.
Don't do any heavy lifting. Your healthcare provider will provide a specific timeline
for lifting restrictions.
Gradually go back to normal activities as much as possible. Ask your healthcare provider
about working and sexual activity.
Know that you will not be able to drive a car for a period of time after the surgery
to allow for healing of the breastbone (sternum) and muscles of the chest wall. Plan
to have someone give you a ride home from the hospital. Ask your healthcare provider
about when you can start driving again.
Watch your wounds for any sign of swelling, redness, bleeding, or discharge and report
these to your medical and surgical team
Tell your healthcare provider about any increasing pain, fever, chest pain, or shortness
Eat a heart-healthy diet and maintain a healthy weight. Eat foods that are low in
salt, cholesterol and fat. Try to eat a diet rich in fruits, vegetables and lean meats.
Don't smoke and stay way from secondhand smoke and all other tobacco products, including
If you need dental work in the future, your healthcare provider may give you antibiotics
to prevent infection of your valve. Before you have any dental procedure, always tell
your dentist you have had valve surgery.
Your healthcare provider may suggest that you begin a cardiac rehab (rehabilitation)
program. This program gradually reintroduces you to a normal lifestyle. Cardiac rehabilitation
begins in the hospital with simple walking, and progresses to a regular exercise routine
and a nutritious diet. Committing to healthier habits can prevent future heart problems.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how you will get the results
Who to call after the test or procedure if you have questions or problems
How much you will have to pay for the test or procedure