Re: Tricuspid valve repair

Posted By CCF CARDIO MD - CRC on June 19, 1998 at 14:19:46:

In Reply to: Tricuspid valve repair posted by Vicki on June 15, 1998 at 20:06:52:






My significant other, Rob, recently underwent cardiac catheterization.  We
were then told he suffers from tricuspid valve regurgitation, and needs to
have his tricuspid valve repaired.  We were told that the repair
consists of placing a ring around the valve to reduce its insufficiency,
and that the procedure is well-established and quite straight-forward as
cardiac surgeries go.  The cardiologist went on to say that since Rob's
condition is in the early stages (his symptoms are limited to mild shortness
of breath and fatigue)and his health is otherwise very good, he doesn't need
to rush into the surgery.  We are trying to process this information, and
make the best decision regarding the surgery.  
The Cleveland Clinic is one of three facilities the cardiologist recommended
for the surgery.  
What should we consider in choosing a facility and a surgeon, and how can
we get information on those considerations for each facility and surgeon?
How can we know what kind of annuloplasty should be done - for example, De
Vega's semicircular annuloplasty vs. adjustable annuloplasty? Are there
minimally invasive options available?  What can we do to evaluate the
risks?  Rob is an avid horseman, sailor, skier, hiker, swimmer and cellist.
The first time he was on roller blades (about 3 years ago), he skated 14
miles - at age 75.  Are there special considerations we need to be aware of
because of his age, even with his remarkable fitness?
Thank you very much for being willing to spend your time answering
questions in this forum.  It's a relief to have a venue such as this to
turn to, and we greatly appreciate your efforts!
  
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Dear Vicki,
Thank you for your question.  There are a few questions I have.  How old is Rob? (84?)   Are there any other reasons that he would need heart surgery? (i.e. - blocked arteries or a second leaky valve)  How severe are his symptoms?  Do they limit him significantly?  Did the doctor mention what the ejection fraction (the pumping capacity) of his heart was?
Generally if the only problem is tricuspid valve regurgitation surgery is not necessary.  If there is a reason that surgery will be done anyhow then the tricuspid valve is repaired at the same time.  The other indications to repair the valve would be severe heart failure and/or severe symptoms due to the regurgitation.  A third indication would be an infected valve.  The type of repair done and the approach used will be up to the surgeon.
In choosing your surgeon and hospital the factors to consider are what is their success rate with the operation in question, how many similar types of cases have they performed, what is the mortality rate, what is the nurse to patient ratio for post-operative care and how is the facility ranked by independent reviewers.  Dr. Cosgrove is one of the surgeons here that has done many, many valve repairs and I would highly recommend him should you need surgery.  The process would be to call [phone] and they will schedule you to see one of the cardiologists here who would order any necessary tests in the evaluation for the need for surgery.
In the meantime you should have regular follow-up with your cardiologist at home  and serial echocardiograms to follow the progress of the valve and pumping chamber function.
Information provided here is for general educational purposes only. Only your doctor can provide specific diagnoses and treatments. If you would like to be seen at the Cleveland Clinic, please Call 1 - 800 - CCF - CARE for an appointment at Desk F15 with a cardiologist