Guidelines for the management of functional tricuspid regurgitation
| American College of Cardiology/American Heart Association (2014)1 | European Society of Cardiology (2017)20 |
|---|---|
| • Tricuspid valve surgery is recommended for patients with severe tricuspid regurgitation (stages C and D) undergoing left- sided valve surgery (Class I, level of evidence C). | • Surgery is indicated in patients with severe secondary tricuspid regurgitation undergoing left-sided surgery (Class I, level of evidence C). |
| • Current guidelines provide for tricuspid valve repair in patients with mild, moderate, or greater functional tricuspid regurgitation at the time of left-sided surgery with either tricuspid annular dilation or prior evidence of right heart failure (Class IIa, level of evidence B). | • Surgery is indicated in patients with mild or moderate secondary tricuspid regurgitation with a dilated annulus (≥ 40 mm or > 21mm/m2 by 2-dimensional transthoracic echocardiography) undergoing left-sided surgery (Class IIa, level of evidence C). |
| • Tricuspid valve repair may be considered for patients with moderate functional tricuspid regurgitation and pulmonary hypertension at the time of left-sided surgery (Class IIb, level of evidence C). | • Surgery may be considered in patients undergoing left-sided surgery with mild or moderate secondary tricuspid regurgitation even in the absence of annular dilation when previous right- sided heart failure has been documented (Class IIb, level of evidence C). |
| • Reoperation for isolated tricuspid valve repair or replacement may be considered for persistent symptoms due to severe tricuspid regurgitation (stage D) in patients who have under- gone previous left-sided valve surgery and who do not have severe pulmonary hypertension or significant right ventricular systolic dysfunction (Class IIb, level of evidence C). | • After previous left-sided surgery and in the absence of recurrent left-sided valve dysfunction, surgery should be considered in patients with severe tricuspid regurgitation who are symptomatic or have progressive right ventricular dilation/dysfunction, in the absence of severe left ventricular/right ventricular dysfunction or pulmonary vascular disease/hypertension (Class IIa, level of evidence C). |