Pathophysiology and management of functional tricuspid regurgitation

Jason H Rogers, Steven F. Bolling

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Functional tricuspid regurgitation (FTR) is an increasingly recognized cause of morbidity and mortality. This clinical entity is most frequently encountered during operations for left-sided heart valve disease, particularly in the setting of functional mitral regurgitation (FMR). Failure to recognize the importance of FTR correction during mitral valve surgery often leads to poor early and late outcomes due to progression of tricuspid regurgitation (TR) and subsequent right heart failure. Consequently, the 2012 ESC/EACTS and 2014 ACC/AHA valvular heart disease guidelines favor a proactive approach to TR correction and highlight the shifting consensus towards more liberal application of surgical therapy. Randomized trials are needed to bolster guideline recommendations further, which are based entirely on retrospective studies. Rigid annuloplasty rings have superior durability and should be used in favor of flexible bands or DeVega-style repairs. Preoperative determinants of clinical outcomes now include echocardiographic parameters of tricuspid valve tenting area and associated right ventricular size and function. Newer percutaneous therapies for FTR may allow less invasive management at the time of percutaneous mitral valve repair or in patients who develop TR late and are at high risk for reoperation. The purpose of this chapter is to review the pathophysiology and current surgical management of functional tricuspid regurgitation, as well as emerging transcatheter therapies.

Original languageEnglish (US)
Title of host publicationPathophysiology and Pharmacotherapy of Cardiovascular Disease
PublisherSpringer International Publishing
Pages1201-1220
Number of pages20
ISBN (Print)9783319159614, 9783319159607
DOIs
StatePublished - Jan 1 2015

Keywords

  • Annuloplasty
  • Outcomes
  • Surgery
  • Transcatheter tricuspid valve repair
  • Tricuspid regurgitation

ASJC Scopus subject areas

  • Medicine(all)
  • Pharmacology, Toxicology and Pharmaceutics(all)

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