Options for Heart Failure

My Dad, 87 y/o, 14 years post-bypass, with an implanated pacemaker to address atrial fib ... has developed CHF with a 35% LVEF. Tricuspid regurgitation (moderate to severe) confirmed by echo. Mitral regurgitation mild to moderate. He is on two diuretic meds (including a potassium-sparing one Spironolactone) and Tenormin. He is still relatively active and in decent shape.

His cardiologist said that tricuspid valve disease is not something that is generally operated on and I have my doubts as to how good a risk he would be for open surgery anyway. Isn't it true that the longer he continues to have this leakage, the more the heart will change it's normal shape (some of the chambers are enlarged already) to try to adjust ... and the worse his CHF will become?

I have already also been told previously that the Percutaneous Tricuspid Valve Repair procedures (actually being tried at the Cleveland Clinic) are not "ready for prime time" as of yet.

Is there anything else that can be done to address his problem?

Thanks in advance for your help!

[Cleveland Clinic]

I think I have addressed these issues in the past. He has LV dysfunction with an ejection fraction of 35%: they need to find out why this is ( if a new finding) by addressing his coronary arteries. Also he may be a candidate for a pacemaker upgrade to a BIV ICD device as he has a cardiomyopathy and CHF. Tricuspid regurgitation may cause right ventricular dysfunction and right heart failure but it isn't usually operated on because the success rate is very low, probably in the 10-20% range. And that operation has a significant morbidity for not much benefit. Extraction of the RV lead, which may be worsening the TR is also not the answer as this can also disrupt the tricuspid apparatus and worsen the TR.