Introduction

The tricuspid valve is located between the right atrium and the right ventricle of the heart and plays an essential role in maintaining unidirectional blood flow within the right side of the heart. It opens to allow blood to flow from the right atrium to the right ventricle and closes during ventricular contraction to prevent backflow. When the tricuspid valve becomes damaged due to conditions like tricuspid regurgitation or stenosis the heart’s efficiency is compromised, leading to symptoms such as fatigue, swelling in the legs or abdomen, liver congestion, and shortness of breath.

While some tricuspid valve problems can be managed with medications, surgery becomes necessary when the condition worsens or causes significant heart dysfunction. Tricuspid valve surgery may be performed as an isolated procedure or alongside surgery on other heart valves, especially in cases of combined mitral or aortic valve disease. The decision to operate and the choice of surgical method depend on the severity of the valve disease, overall heart function, comorbid conditions, and the patient’s physical condition.

Process of Tricuspid Valve Surgery

Initial Diagnosis and Evaluation :- The process begins with clinical evaluation when a patient reports symptoms such as swelling in the legs, fatigue, abdominal bloating, or difficulty breathing. A physical exam may reveal signs of right-sided heart failure, including fluid buildup or liver enlargement. Transthoracic or transesophageal echocardiography is typically used to assess the structure and function of the tricuspid valve. This imaging helps identify whether the valve is leaking (tricuspid regurgitation), narrowed (tricuspid stenosis), or both. Additional imaging such as cardiac MRI, CT scans, or right heart catheterization may be performed for more detailed assessment. The heart team, including cardiologists and cardiothoracic surgeons, evaluates the findings and determines whether surgical intervention is appropriate.
Preoperative Preparation :- Once surgery is recommended, patients undergo thorough preoperative assessment, including blood tests, chest X-rays, ECG, pulmonary function testing, and evaluation of kidney and liver function. A consultation with the anesthesiologist is conducted to assess airway and anesthesia risk. Patients are advised to stop certain medications like blood thinners or diuretics before the procedure. Fasting for 6–8 hours prior to surgery is required. The surgical team explains the nature of the surgery, risks, expected outcomes, and recovery plan. This is also the stage where the decision is made between repair and replacement and whether a mechanical or biological valve will be used, if replacement is needed.
Access to the Heart :- On the day of surgery, the patient is taken to the operating room and placed under general anesthesia. A breathing tube is inserted, and the patient is connected to a ventilator. To access the heart, a median sternotomy (incision through the breastbone) is typically performed. In minimally invasive approaches, smaller incisions are made between the ribs on the right side of the chest. Once the heart is exposed, the patient is connected to a cardiopulmonary bypass machine. This machine temporarily takes over the function of the heart and lungs, allowing the surgeon to operate on a motionless, bloodless field.
Assessment of the Tricuspid Valve :- Once the heart is stabilized, the surgeon closely examines the tricuspid valve. If the valve is structurally intact but functioning poorly due to dilation or annular stretching, valve repair may be attempted. However, if the valve is extensively damaged by infection, calcification, or congenital malformation, replacement may be more suitable. A key advantage of surgical exposure is that the surgeon can directly visualize the valve and decide on the most effective strategy in real time. In many cases, repair is attempted first, as it preserves the patient’s native valve and avoids the need for long-term anticoagulation.
Tricuspid Valve Repair :- During tricuspid valve repair, techniques such as annuloplasty are commonly used. This involves placing a ring around the valve opening to restore its normal shape and size, ensuring better leaflet coaptation and preventing leakage. Other repair techniques include leaflet patching, chordal shortening, or commissurotomy if stenosis is present. In valve replacement, the damaged valve is excised and replaced with either a mechanical valve (made of durable synthetic materials) or a bioprosthetic valve (made from pig, cow, or human donor tissue). Mechanical valves last longer but require lifelong anticoagulation, while tissue valves are more natural but tend to wear out over 10–15 years. The new valve is sewn securely into place to ensure it functions effectively.
Weaning Off Bypass :- After the valve has been repaired or replaced, the heart is carefully restarted, and the patient is weaned off the cardiopulmonary bypass machine. The surgical team monitors for any signs of bleeding, arrhythmia, or valve dysfunction. Once the heart is functioning well, the chest cavity is closed. In a full sternotomy, the breastbone is wired back together, and the skin is sutured or stapled closed. If a minimally invasive approach was used, the smaller incisions are closed with dissolvable stitches or surgical glue. Drainage tubes may be placed temporarily to remove excess fluids from the chest.
Postoperative ICU Monitoring :- Following surgery, the patient is transferred to the intensive care unit (ICU) for close monitoring. Vital signs, oxygen levels, heart rhythm, urine output, and neurological status are observed continuously. Pain is managed with IV medications, and breathing support is provided if needed. Most patients remain in the ICU for 24–48 hours before being moved to a general cardiac recovery ward. Breathing tubes, urinary catheters, and IV lines are gradually removed as the patient stabilizes. Early mobilization, including sitting up and walking with assistance, is encouraged to prevent complications such as pneumonia or blood clots.
Hospital Recovery :- The hospital stay after tricuspid valve surgery typically lasts 5–7 days, depending on the complexity of the surgery and the patient’s overall recovery. Patients are gradually transitioned from IV to oral medications, including pain relievers, diuretics, and possibly anticoagulants. Instructions regarding wound care, dietary recommendations, and medication adherence are provided. Patients are advised to avoid lifting heavy objects or driving for 4–6 weeks. A follow-up appointment is scheduled within a few weeks of discharge to assess healing, monitor heart function, and adjust medications as needed.
Long-Term Recovery :- Full recovery may take several weeks to a few months, during which cardiac rehabilitation is often recommended. These structured programs include supervised exercise sessions, nutritional guidance, psychological support, and education on heart health. Patients with mechanical valves will be educated on INR monitoring and blood thinner management. Routine follow-up with a cardiologist is essential to monitor valve function and overall cardiac performance through echocardiograms and clinical evaluations. Most patients experience a significant improvement in energy levels, breathing, and overall quality of life after a successful tricuspid valve surgery.

Conclusion

The process of tricuspid valve surgery involves a detailed and coordinated pathway that begins with accurate diagnosis and extends through surgery, recovery, and long-term follow-up. Each stage preparation, anesthesia, surgical technique, postoperative care, and rehabilitation is critical in achieving a successful outcome and restoring healthy heart function.

Whether the surgery involves valve repair or replacement, open or minimally invasive techniques, the ultimate goal remains the same: to improve blood flow, relieve symptoms, prevent heart failure, and enhance the patient’s quality of life. With the advancements in surgical procedures and technology, most individuals undergoing tricuspid valve surgery can look forward to excellent results and a strong recovery.

Careful patient selection, timely intervention, and a collaborative heart team approach are the cornerstones of optimal treatment. By understanding the entire surgical process, patients and their families are better equipped to face the journey with clarity and confidence.