title: Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.
abstract: The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.
authors.affiliation: Department of Heart Surgery, Vita-Salute University of Milan, 20132, Milan, Italy. pozzoli.alberto@hsr.it.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.affiliation: Department of Heart Surgery, Vita-Salute University of Milan, 20132, Milan, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Lapenna
authors.affiliation: Department of Heart Surgery, Vita-Salute University of Milan, 20132, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Vicentini
authors.affiliation: Department of Heart Surgery, Vita-Salute University of Milan, 20132, Milan, Italy.
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
authors.affiliation: Department of Heart Surgery, Vita-Salute University of Milan, 20132, Milan, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D058385:Cardiac Valve Annuloplasty / Q000379:methods*; D004108:Dilatation, Pathologic / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery
keywords: Moderate functional tricuspid regurgitation; Right heart failure; Right ventricular function; Transcatheter tricuspid repair; Tricuspid regurgitation; Tricuspid valve; Tricuspid valve repair; Tricuspid valve surgery