If the doctor decides to repair your tricuspid valve, the only option is surgery. The surgeon will repair your valve based on the type of tricuspid defect you have. Repair can be accomplished by:

• Closing the holes (fenestrations) in the leaflets of the valve

• Separating tethered valve leaflets

• Reshaping the valve leaflets so they are in contact with another to prevent backflow of blood

• If you have Ebstein’s anomaly, some surgeons will perform a newer procedure called a “cone repair”. The tricuspid leaflets will be separated from the underlying heart muscle and rotated and reattached to form a “leaflet cone”.

Advantages of having your tricuspid valve repaired rather than replaced are that the functioning valve is from your own tissue, which decreases your chance of infection and does not require you to take blood-thinning medication, and increases right ventricle function.

However, if your tricuspid valve is deemed unfit for repair, the tricuspid valve will be replaced. In tricuspid valve replacement, the surgeon will remove parts of the tricuspid valve and replace it with either a mechanical valve or a biological (bioprosthetic) valve. The decision to use either a mechanical or biological valve will be based on many factors such as durability, use of medication, and need for additional surgery. A mechanical valve lasts longer but blood-thinning medication must be taken for life to prevent clots from forming on the device, which can lead to serious events such as heart attack and stroke. A biological valve (which is made from animal tissue) does not require you to take lifelong medication but the probability of needing another valve replacement in the future is higher. You and your doctor can decide on a valve that fits your physical needs and lifestyle.

Unlike tricuspid valve repair, your tricuspid valve can be replaced either surgically or with a less invasive approach, known as a transcatheter valve replacement. Although surgery is the more common approach in replacing the tricuspid valve, there is a higher risk of post-procedural complication and mortality in these patients. A transcatheter valve replacement provides a less invasive procedure for patients that are too high risk for open-heart surgery. This is a relatively novel procedure and studies are currently underway in determining the efficacy of a transcatheter approach compared to the surgical approach. Therefore, most transcatheter tricuspid valve replacements are performed if a patient had a previous surgical biological tricuspid valve repair that is no longer functioning. This procedure uses a catheter that is inserted into a blood vessel in your neck or leg and is then guided to your heart using x-ray imaging. The original bioprosthetic valve in the heart will be inflated by a balloon which is attached to the end of the catheter and a new valve will be deployed within it.

There are additional procedures that are also performed to treat the underlying causes and/or symptoms:

• Catheter ablation: if you are experiencing fast or irregular heart rhythm, your doctor may perform a catheter ablation in which a catheter is guided through your blood vessels to the heart which then delivers heat, extreme cold, or radiofrequency energy to create a bit of scar tissue in your heart to prevent electrical impulses that are causing the abnormal heart rhythm.

• Maze procedure: a surgical approach in treating fast heart rhythms. The surgeon will make small incisions in your heart to produce scar tissue that will block electrical impulses that are causing the fast heart rhythm. This procedure is more invasive and is usually performed during a surgical valve repair or replacement.