Tricuspid Valve Repair or Replacement

The tricuspid valve is one of four valves that regulate blood flow through the heart. The tricuspid valve has three flaps that, when closed, keeps blood from going back into the heart. In tricuspid valve disease, the tricuspid valve may not be closing properly (regurgitation), may be narrowed (stenosis), may be missing (atresia) or may be malformed (Ebstein’s anomaly).

To address either condition, tricuspid valve surgery (repair and/or replacement) can be performed. Tricuspid valve surgery is performed through open-heart surgery.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.

How to Prepare for the Procedure

Before the procedure, your doctor and treatment team will explain to you what to expect before, during and after the procedure and potential risks of the procedure. Talk to your doctor about:

• All medications, herbal products and dietary supplements you are currently taking and ask for their recommendations about each.
• Diabetes and how to adjust your medicine on the day of the procedure.
• Radiation exposure, especially for those that are pregnant.
• Any allergies to medicines, latex, tape, iodine, and anesthetic agents.
• Any history of bleeding disorders.
• Any implanted device (e.g. pacemaker or ICD).
• Any body piercings on your chest or abdomen.

Other recommendations include:

• Eat a normal meal the evening before the procedure. However, do not eat, drink or chew anything after midnight before your procedure. If you must take medications, only take them with sips of water.
• Leave all jewelry at home.
• Remove all makeup and nail polish.
• Wear comfortable clothing when you come to the hospital.
• If you normally wear dentures, glasses, or hearing devices at home, plan to wear them during the procedure.

What to Expect Before the Procedure

Before the procedure, your doctor may perform a variety of diagnostic tests, including:

• Cardiac Catheterization
• Computed Tomography (CT scan)
• Magnetic Resonance Imaging (MRI)
• X-Rays
• Echocardiogram (ECHO)
• Electrocardiogram (EKG/ECG)
• Stress Test

What to Expect During the Procedure

This type of open-heart surgery usually takes anywhere from 2 to 4 hours, but preparation and recovery may add several hours. This procedure is usually performed in the cardiothoracic operating room (OR). Check with your doctor about the details of the procedure. In general:

• You will change into a hospital gown.
• A nurse will start the intravenous (IV) line in your arm which will administer medications and fluids during the procedure.
• Prior to starting the procedure, you will receive a local anesthetic. Once you are sedated, your doctor may insert a breathing tube through your throat into your lungs and connect you to a ventilator. This will breathe for you during surgery.
• Your doctor will administer general anesthesia (will make you feel sleepy).
• The procedure begins when your doctor exposes your heart by dividing the breastbone in half. Your doctor then spreads both halves to gain access to your heart (open-heart surgery).
• For this type of surgery, your heart must be still. Prior to doing so, your doctor will place tubes into your heart so that blood can be pumped through your body by use of a heart-lung machine. This machine takes over for the heart by replacing the heart’s pumping action and the lungs by adding oxygen to the blood.
• Once the blood has been diverted into the bypass machine for pumping, your doctor will then stop the heart by injecting it with a cold solution.

If Your Valve Is Being Repaired:

When the heart has been stopped, your doctor will begin to repair your tricuspid valve. Several repair options include:

• Inserting tissue to patch holes or tears in the flaps (perforated leaflets) that close off the valve.
• Adding support at the base or roots of the valve.
• Separating fused valve leaflets.
• Reshaping or removing tissue to allow the valve to close more tightly.
• Tightening or reinforcing the ring around a valve (annulus) by implanting an artificial ring (annuloplasty).

If Your Valve Is Being Replaced:

• When the heart has been stopped, your doctor will remove the tricuspid valve and replace it with a mechanical valve or a valve made from cow, pig, or human heart tissue.

Once the valve is repaired and/or replaced, the doctor will make sure everything is working properly. Once checked, the doctor will let the blood circulating through the bypass machine back into your heart. If your heart is not restarting after the procedure is complete, a mild electric shock may be used to restart it. Your doctor may also put temporary wires for pacing into your heart. These wires can be attached to a pacemaker, if needed, during the initial recovery period. Once the procedure is complete, the heart-lung machine will be turned off. The tubes will be removed and the sternum will be sewn together with the use of sutures or surgical staples.

What to Expect After the Procedure

After the procedure, you will be taken to the cardiothoracic intensive care unit (CTICU) for further observation for several days. This procedure usually requires a hospital stay of several days or even longer. Other recommendations include:

General Guidelines

• The breathing tube is removed when you wake up from anesthesia.
• Diet is started the day after surgery with liquids, and quickly advanced to solids as tolerated.
• Ambulation is started on the first or second day of surgery.
• Urine catheters and drainage tubes (chest tubes) are removed after 24 to 48 hours.
• If you have pacing wires, your doctor will remove those too.
• Nurses, respiratory therapists, and physical therapists will work with you as you begin physical therapy and breathing exercises.
• Your doctor will give you instructions to follow during your recovery.
• A cardiac rehabilitation program may also be suggested.

Do you have a question? Request more information and we will connect you with an RWJBarnabas Health cardiovascular expert.