From the Guidelines
Surgery for tricuspid valve tumors should involve complete surgical excision with valve repair or replacement, prioritizing valve-sparing techniques when possible, as recommended by the most recent guidelines 1.
Key Considerations
- The surgical approach must be individualized based on tumor size, location, malignancy status, and patient factors.
- Valve repair is preferable to replacement, with tricuspid valve repair not adding appreciably to the risks of surgery and can be accomplished with a clinically insignificant increase in ischemic time 1.
- When replacement is necessary, the choice of prosthesis should be individualized, with the usual trade-offs between thrombosis/anticoagulation with a mechanical valve and durability with a tissue valve.
Surgical Options
- Open-heart surgery through a median sternotomy with cardiopulmonary bypass is the most common approach.
- Minimally invasive approaches through right mini-thoracotomy or robotic assistance may be options for selected patients with favorable anatomy.
Postoperative Care
- Anticoagulation management, cardiac rehabilitation, and regular echocardiographic follow-up to monitor for recurrence, especially with myxomas which have a 1-3% recurrence rate.
Outcomes
- Surgical outcomes are generally excellent for benign tumors with low operative mortality (1-3%) when performed at experienced cardiac centers 1.
Guidelines
- The 2014 AHA/ACC guideline for the management of patients with valvular heart disease recommends tricuspid valve surgery for patients with severe TR (stages C and D) undergoing left-sided valve surgery 1.
- The guideline also recommends tricuspid valve repair as the preferred approach, with replacement considered when necessary 1.
From the Research
Tricuspid Valve Tumor Surgery Options
- Tricuspid valve disease is a significant clinical problem associated with morbidity and mortality, and treatment options are evolving 2.
- Surgical tricuspid valve repair or replacement has been the treatment of choice, but high mortality rates have been reported, especially for isolated surgical tricuspid valve intervention 3, 4.
- Transcatheter tricuspid valve interventions are emerging as a less invasive alternative, with several systems under clinical use or evaluation 3, 2, 5, 6.
- The selection of patients for transcatheter tricuspid valve interventions is crucial, and factors such as disease stage, anatomical considerations, and patient characteristics should be taken into account 5, 6.
- Early intervention, before severe right ventricle dysfunction and pulmonary hypertension, seems to result in better postoperative outcomes 5.
- Tricuspid annuloplasty is the preferred surgical technique, given its superior long-term outcomes, while replacement is reserved for advanced or organic tricuspid disease 4.
Surgical Options
- Tricuspid annuloplasty: a surgical technique that involves repairing the tricuspid valve annulus to improve valve function 4.
- Tricuspid valve replacement: a surgical procedure that involves replacing the tricuspid valve with a prosthetic valve 4.
- Transcatheter tricuspid valve interventions: a less invasive alternative to surgical repair or replacement, using catheter-based systems to treat tricuspid valve disease 3, 2, 5, 6.
Considerations for Patient Selection
- Disease stage: early intervention is recommended to prevent severe right ventricle dysfunction and pulmonary hypertension 5.
- Anatomical considerations: the tricuspid valve anatomy is complex and variable, and imaging techniques such as echocardiography can be challenging 6.
- Patient characteristics: factors such as age, comorbidities, and overall health status should be taken into account when selecting patients for transcatheter tricuspid valve interventions 5, 6.