Chirurgische Therapie der funktionellen Trikuspidalklappeninsuffizienz

Abstract

Functional tricuspid regurgitation (TR) is a complex valvular lesion primarily arises from asymmetric dilatation of the tricuspid annulus in the setting of right ventricular dysfunction and enlargement in response to left-sided heart disease. The traditional view that functional TR generally resolves with surgical correction of the primary lesions is no longer hold. Concurrently, if untreated at the time of surgical mitral valve repair, significant residual TR negatively impacts perioperative outcomes, functional class and survival. Tricuspid ring annuplasty can be performed with minimal incremental morbidity and negligible mortality. Therefore, in addition to patients with severe regurgitation, annuplasty is now also recommended for patients with moderate TR or severe annular dilatation at the time of left-heart cardiac procedures. In combination with tricuspid ring annuplasty, the right ventricular reduction surgery as a novel adjunct procedure appears to be a promising strategy to avoid residual TR in this endangered patient population. In this article, we review the anatomy, pathophysiology, and value of surgical correction of TR, including the right ventricular reduction procedure.

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