From the Guidelines
Surgery should be considered for tricuspid valve repair in patients with severe tricuspid regurgitation (TR) who are symptomatic, have right-sided heart failure, or have progressive RV dilation or systolic dysfunction, as recommended by the European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) guidelines 1. When deciding on surgical intervention, several factors should be taken into account, including the type and severity of TR, the presence of left-sided valve disease, and the patient's overall health status.
- For symptomatic patients with isolated severe primary TR, TV surgery can be beneficial to reduce symptoms and recurrent hospitalizations 1.
- For patients with severe secondary TR undergoing left-sided valve surgery, TV surgery is recommended 1.
- In asymptomatic patients with isolated severe primary TR and progressive RV dilation or systolic dysfunction, TV surgery may be considered 1. The benefits of surgery, including improved symptoms and reduced hospitalizations, must be weighed against potential risks, such as infection and anesthesia complications. Key considerations for surgical timing include the presence of severe RV dysfunction, pulmonary hypertension, or left-sided disease, which may influence the decision to operate 1. Ultimately, the decision for surgical intervention should be individualized based on the patient's specific clinical scenario and made in consultation with a multidisciplinary team of healthcare professionals.
From the Research
Surgical Repair Considerations
- Surgery should be considered for herniated discs with absolute surgical indications, including deteriorating neurological deficits with myelopathy or cauda equina syndrome 2.
- For cervical disc herniation (CDH), surgery may be indicated after six months of persisting symptoms that do not respond to conservative treatment 2.
- In thoracic disc herniation (TDH), surgery may be considered in cases of failure of conservative measures, worsening neurological symptoms, or giant calcified thoracic disc herniations 2.
- For lumbar disc herniation (LDH), surgery may be indicated when there is imaging confirmation of LDH, consistent with clinical findings, and failure to improve after six weeks of conservative care 2.
- Inguinal hernia repair is typically considered for symptomatic hernias, while watchful waiting may be a reasonable option for asymptomatic or minimally symptomatic inguinal hernias in men 3, 4.
- Laparoscopic repair is often preferred over open repair for inguinal hernias due to its association with shorter recovery time, less pain, and lower recurrence rates 3, 4.
Patient-Specific Factors
- The decision to undergo surgery should take into account the patient's overall health, medical history, and personal preferences 5.
- Patients with serious illnesses, such as heart failure, advanced cancer, or end-stage renal disease, may require special consideration when evaluating the need for surgical repair 5.
- Alternative therapies, such as acupuncture, tai chi, or osteopathic manipulative medicine, may be considered as adjunctive treatments for chronic pain management, but their effectiveness for surgical repair is unclear 6.