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Tricuspid Valve Repair vs Replacement — EECC MCQ

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ModerateValvular Heart DiseaseTricuspid Valve Repair vs ReplacementEECC

A 60-year-old man with severe symptomatic secondary TR (due to AF-related annular dilatation) and preserved RV function is reviewed by the Heart Team. Medical therapy (diuretics, AF management) has failed to improve symptoms. What surgical intervention is recommended?

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Correct answer: E — Tricuspid valve repair (annuloplasty) is preferred over replacement for secondary TR when technically feasible

For severe symptomatic secondary TR refractory to medical therapy, the 2025 ESC/EACTS VHD Guidelines recommend surgical intervention. Tricuspid annuloplasty (repair) is the preferred approach over replacement (Class IIa) because: (1) it preserves the native valve apparatus, (2) lower operative mortality, (3) avoids prosthesis-related complications. Ring annuloplasty is preferred over suture techniques for more durable results. Replacement (bioprosthetic preferred over mechanical due to high thrombosis rates) is reserved for cases with organic leaflet disease or failed repair. Importantly, the guidelines emphasise early referral before irreversible RV dysfunction develops, as late intervention when the RV is severely dilated/dysfunctional carries worse outcomes.

Reference: ESC/EACTS (2025): Guidelines for the Management of Valvular Heart Disease