Before
A member of your care team may shave hair from the body area where the surgical cuts, called incisions, will be made. A special soap is usually used to wash your skin to help prevent infection.
During
Tricuspid valve repair or replacement may be done as open-heart surgery or as minimally invasive heart surgery. Open-heart surgery involves making a surgical cut, called an incision, through the middle of the chest to reach the heart. Minimally invasive heart surgery involves much smaller incisions than those used in open-heart surgery. Sometimes, tricuspid valve disease may be treated using thin, flexible tubes called catheters.
For most tricuspid valve repair and tricuspid valve replacement surgeries, you get a combination of medicines to put you in a sleep-like state. This is called general anesthesia. You are connected to a heart-lung bypass machine, which keeps blood moving through the body during the surgery.
Tricuspid valve repair
Heart doctors recommend heart valve repair when possible. It saves the heart valve and avoids the need for a replacement heart valve. It also can help save heart function.
Tricuspid valve repair is usually done with open-heart surgery. Sometimes, a tricuspid valve can be repaired with minimally invasive surgery.
During tricuspid valve repair, a surgeon might:
- Patch holes or tears in the valve flaps.
- Reconnect valve flaps, called leaflets.
- Reshape or remove extra valve tissue so that the flaps can close tightly.
- Replace cords that support the valve for better support.
- Separate valve flaps that have joined together.
- Tighten or strengthen the ring around the valve, called the annulus.
If tricuspid regurgitation is caused by Ebstein anomaly, heart surgeons may do a type of valve repair called a cone procedure. During a cone procedure, the heart surgeon separates the flaps that close off the tricuspid valve from the underlying heart muscle. The flaps are then rotated and reattached.
Minimally invasive tricuspid valve repair
Minimally invasive tricuspid valve repair typically involves smaller surgical cuts and a shorter hospital stay than traditional open-heart surgery.
One minimally invasive method to treat infants and children with tricuspid valve stenosis is balloon valvuloplasty. It also is called balloon valvotomy.
During balloon valvuloplasty, a surgeon places a thin, hollow tube called a catheter into a blood vessel, usually in the groin, and guides it to the heart. A balloon on the tip of the catheter is inflated. This widens the narrowed tricuspid valve. The balloon is deflated and removed.
Treatments using catheters are currently being developed for some patients with tricuspid regurgitation who can't have surgery. A healthcare professional may discuss this option in special circumstances.
Tricuspid valve replacement
If the tricuspid valve can't be repaired, surgery may be done to replace the valve. Tricuspid valve replacement surgery may be done as open-heart surgery or minimally invasive surgery.
During tricuspid valve replacement, a surgeon removes the damaged or diseased valve. The valve is replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. A tissue valve is called a biological valve.
Together, you and your healthcare team talks about the risks and benefits of each type of valve to determine the one that's best for you.
If you have a mechanical valve, you need to take blood thinners for the rest of your life to prevent blood clots. Biological tissue valves don't require lifelong blood thinners. But they can wear down over time and may need to be replaced.
Valve-in-valve replacement
If you have a biological tissue tricuspid valve that's no longer working, valve replacement may be done using thin, flexible tubes called catheters instead of open-heart surgery. The doctor inserts the catheter into a blood vessel and guides it to the tricuspid valve. The replacement valve goes through the catheter and is placed into the existing biological valve.
After
After tricuspid valve repair or replacement surgery, you generally stay in the hospital for several days. How long you stay depends on your condition and specific type of tricuspid valve surgery.
During the hospital stay, you may have:
- An IV to receive fluids and medicines.
- Tubes to drain urine from your bladder.
- Tubes to drain fluid and blood from your heart and chest.
Your care team will:
- Check for infection at your incision sites.
- Regularly check your blood pressure, breathing and heart rate.
- Help you manage pain after surgery.
- Ask you to take longer and longer walks to increase your activity.
- Show you how to do breathing exercises as you recover.
Your healthcare team gives you instructions to follow after tricuspid valve repair or replacement surgery. These instructions typically have details about the following:
- The medicines you are taking.
- The warning symptoms of infection.
- How to care for your surgical cuts.
- How to manage pain.
- The side effects of surgery.