Surgical treatment of tricuspid regurgitation.

The technique of tricuspid valve repair for tricuspid regurgitation has been used effectively since 1961. The first publication of the method appeared in 1965 in the Annals of Surgery. The procedure has changed little since that time and has afforded excellent long-term results. The procedure consists of excluding the annulus of the posterior leaflet of the tricuspid valve. The technique is simple, fast, hemodynamically effective, and durable. It carries no risk of heart block because the posterior leaflet annulus is far from the conduction system. An inferior caval snare may produce inadequate drainage with resulting increased back pressure on the liver leading to hepatocellular necrosis and lethal postoperative liver dysfunction in 3 to 5 days. Therefore, an inferior caval snare is never used when repairing or replacing the tricuspid valve for acquired or rheumatic heart disease. Morbidity and mortality are also decreased by restricting fluids in the postoperative period.