Options for Tricuspid Regurgitation

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 several diuretic meds, but they were recently increased in dosage to address ankle edema. Still relatively active and in decent shape.

His cardiologist seems to be taking (what I feel is) a conservative approach. He said that tricuspid valve disease is not something that is generally operated on. I myself feel that he might not be the best risk for surgery anyway. However, I am reading about some new "alternative" techniques such as percutaneous tricuspid valve repair and other percutaneous techniques for dealing with tricuspid valve disease (although I know they are not necessarily in widespread practice as of yet) that it seems to me are less risky than surgery, and I feel may extend his life. When I brought the question up to his cardiologist, his response was why look for trouble if he's doing reasonably well on meds? My problem is that I believe 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.

Does it make any sense to pursue these newer alternative techniques, or do I just need to accept what we are being told. I realize people don't live forever, but would like to have my Dad for as long as I can ... and certainly ... I would feel terrible if I later found out that I should have pushed harder to look into this.

Thanks in advance for your help!

Larry

[Cleveland Clinic]

The tricuspid valve is the hardest of all the four valves to operate on because of its very complex anatomy. Even with open approaches int he hands of the most experienced surgeons very good results occur only in 20-25%. Most of the time there are only option to repair the valve and replacement is not an option, because the prosthetic valves do not assume the shape of the annulus very well. So to operate on an 87 year old with an ejection fraction of 35% simply to repair his tricuspid valve would not be very likely to have a good outcome, and he may suffer a setback during surgery.
I am not aware of any percutaneous approach to repair the tricuspid valve. We have some approaches for the mitral and aortic valves ( even percutaneously replacement) but not for  the tricuspid valve. It is also difficult to quantify the amount of TR on echo, and to distinguish moderate from severe is not trivial.

[larrye]

Thanks for your reply ... and for clarifying why it is so difficult to achieve good results with tricuspid repairs. Have you seen this?

"Percutaneous Tricuspid Valve Replacement" (at bottom of page):

http://my.clevelandclinic.org/heart/percutaneous/percutaneousValve.aspx

I know it says it's "In Development", but I was hoping maybe it was far enough along.