左心瓣膜替换术后经右胸前外侧切口行孤立性三尖瓣关闭不全的外科治疗

目的总结经右胸前外侧切口行左心瓣膜置换术后孤立性三尖瓣关闭不全的外科治疗经验。方法选取我院2010年3月~2014年8月收治的左心瓣膜置换术后单纯三尖瓣重度关闭不全患者21例作为研究对象,采用右胸前外侧切口,右侧股动脉及带气囊上下腔静脉插管建立体外循环,在常温心脏跳动下行手术16例,降温诱导室颤情况下5例,行三尖瓣成形14例及三尖瓣人工瓣膜置换7例。结果患者均顺利完成手术,未出现严重并发症或死亡。结论左心瓣膜替换术后出现的单纯重度三尖瓣关闭不全,采用右胸前外侧切口手术治疗操作简便,安全可行。     

左心瓣膜置换术后三尖瓣关闭不全的外科治疗

目的 探讨左心房室瓣置换术后三尖瓣关闭不全的外科处理方法。 方法 回顾性分析2007年1月至2017年1月我院在左心瓣膜置换术后出现三尖瓣重度关闭不全再次手术42例患者的临床资料。 结果 手术患者42（男11，女31）例。年龄30～66（52±11）岁。18例（43%）为人工瓣膜功能正常，其余24例（57%）均并发不同程度的主动脉瓣和（或）二尖瓣瓣周漏。两次手术间隔1~19（11±4）年。采用三尖瓣成型环成形31例；采用三尖瓣置换11例，其中，3例为生物瓣膜，8例为双叶机械瓣膜。术后早期院内死亡6例，病死率为14%，其中三尖瓣成形2例，三尖瓣置换4例。致死原因，右心功能衰竭3例，多脏器功能衰竭2例，因凝血功能障碍，出血导致死亡1例。全组随访37例，随访率88%，随访时间6～120（73±31）个月，失访5例（失访率为12%）。随访病例中，5例三尖瓣人工瓣置换患者三尖瓣功能良好。26例三尖瓣成形患者中无或少量返流22例，中量以上返流4例。 结论 左心瓣膜置换术后出现三尖瓣重度关闭不全，行三尖瓣置换或三尖瓣成形术可达到满意疗效。术前心功能的调控及全身各脏器功能的评估是手术成功的保障。依据三尖瓣结构不同的病理改变，选择适合的手术方式也是确保手术成功的关键。     

鲁登巴赫综合征的外科治疗

目的总结10例鲁登巴赫综合征的外科治疗经验。方法我院自2006年6月至2010年6月共收治鲁登巴赫综合征10例,男性2例,女性8例。其中房间隔缺损均为先天性,二尖瓣病变先天性1例、风湿性9例。术中10例均行房间隔缺损心包补片修补术,行二尖瓣置换术8例、二尖瓣成形术2例。同期行三尖瓣Devega成形术6例、左心耳结扎术4例。结果10例患者均无围手术期死亡,术后均未出现顽固性心力衰竭、肺动脉高压危象及恶性心律失常等严重手术相关并发症。结论早期行房间隔缺损修补术同期解除二尖瓣狭窄及处理合并的三尖瓣关闭不全,加强围手术期处理,可取得满意的手术效果。     

糖尿病患者左心系统瓣膜置换术同期行三尖瓣成形术疗效分析

目的对糖尿病患者左心系统瓣膜置换术同期行三尖瓣成形术治疗心脏瓣膜病的疗效进行分析,总结糖尿病患者进行心脏瓣膜手术时的注意事项,为糖尿病患者进行心脏瓣膜手术提供临床依据,以确保手术的安全、有效。方法选取2014年3月—2015年3月到该院住院治疗的进行左心系统瓣膜置换术同期行三尖瓣成形术的糖尿病患者26例,分析患者手术前后心脏功能变化情况,评价治疗效果。结果术后有2例患者由于并发症死亡,从整体来看患者术后左心室射血分数增加,右心房及右心室内径变小,三尖瓣返流程度减轻。出院前患者心功能分级Ⅰ级3例,Ⅱ级14例,Ⅲ级6例,Ⅳ级1例,与术前心功能分级Ⅱ级5例,Ⅲ级13例,Ⅳ级8例相比,患者整体心脏功能提高。结论糖尿病患者在心脏手术过程中要严格控制血糖,术中要严格遵照无菌操作,术后要严防感染,糖尿病患者左心系统瓣膜置换术同期行三尖瓣成形术治疗心脏瓣膜病效果确切、满意。     

重症心脏瓣膜病的外科治疗(附75例报告)

对75例重症心脏瓣膜病患者施行瓣膜置换术。均采用机械瓣。患者术前心功能Ⅲ级28例，Ⅳ级47例。共行二尖瓣置换术29例．主动脉瓣置换术9例，二尖瓣＋主动脉瓣置换术37例。同时施行三尖瓣成形术62例，左房血栓清除术17例，左房成形术12例，冠状动脉搭桥术4例。术后早期死亡5例。认为良好的术前准备、恰当的手术时机和手术方式．积极防治并发症可提高重症心脏瓣膜病的疗效。     

瓣膜置换和成形术治疗二尖瓣置换术后三尖瓣关闭不全患者的疗效比较

目的比较瓣膜置换和成形术治疗二尖瓣置换术后三尖瓣关闭不全的效果。方法抽调2015年10月至2017年7月在深圳市孙逸仙心血管医院诊治的20例二尖瓣置换术后三尖瓣关闭不全患者作为研究对象,按照治疗的不同分为两组,各组10例。其中对照组采用瓣膜置换术,研究组实施三尖瓣成形术,比较两组患者手术前后超声心动图的各项指标、心脏各项指标、心功能分级情况及治疗效果。结果术前两组患者超声心动图的各项指标、心脏各项指标、心功能分级情况比较,差异无统计学意义(P0.05)。术后研究组各项指标包括胸腔引流液[(1 004.12±490.63)mL vs.(1 198.65±403.56)mL,t=0.968,P=0.346]及体外循环时间[(92.54±32.54)min vs.(135.10±25.47)min,t=3.257,P=0.004]等均显著优于对照组,差异有统计学意义。结论通过对二尖瓣置换术后三尖瓣关闭不全的患者采取三尖瓣成形术治疗,治疗后各项心脏功能得到改善,效果显著,值得应用。     

二尖瓣闭式扩张术后瓣膜置换术临床分析

目的总结二尖瓣闭式扩张术后瓣膜置换术的经验及提高治疗效果的措施.方法分析上海长海医院自2001年8月至2002年7月二尖瓣闭式扩张术后瓣膜置换术34例,二尖瓣闭式扩张术至瓣膜置换术间隔平均时间为4～29(12.5±6.73)年.其中,二尖瓣置换术2例(5.9%),二尖瓣置换 三尖瓣成形术16例(47.1%),二尖瓣置换 主动脉瓣置换术2例(5.9%),二尖瓣、主动脉瓣双瓣置换 三尖瓣成形术14例(41.2%).并与同期风湿性心脏病瓣膜置换术患者有关临床资料对照分析.结果二尖瓣闭式扩张术后瓣膜置换术患者与同期风湿性心脏病瓣膜置换术患者在性别、年龄、心功能、手术方式、体外循环时间、主动脉阻断时间以及手术后早期死亡率等方面比较差异无统计学意义.结论对二尖瓣闭式扩张术后复发或病情加重的患者应尽早行瓣膜置换,加强围手术期合理治疗、有限分离心包粘连、术后加强血流动力学监测、注意心功能支持及呼吸支持等措施,可进一步提高手术效果.     

人工心脏瓣膜置换术297例分析

目的总结我院2001年1月至2007年1月297例心脏瓣膜置换手术临床经验。方法手术在全麻体外循环中度低温下进行，全组共297例，其中行二尖瓣置换术（MVR）152例、主动脉瓣置换术（AVR）46例（其中主动脉根部拓宽主动脉瓣置换8例）、双瓣膜置换术（DVR）97例、三尖瓣置换术（TVR）2例。合并三尖瓣关闭不全（’rR）者行DeVega或Kay成形术，术中同期行冠状动脉搭桥4例、行射频消融Maze手术治疗房颤1例。结果早期死亡10例，死亡率3．4％，其中MVR、AVR、DVR的死亡率分别为2．6％、6．5％和3．1％。结论瓣膜置换术是治疗心脏瓣膜病变的可靠、有效手段。加强围术期处理，选择恰当的手术时机，缩短手术时间，加强心肌保护，提高手术技巧，保留二尖瓣下结构，积极处理三尖瓣反流。主动脉瓣置换时，尽可能置入大一号的瓣膜，减少跨瓣压差，以利术后左室重构，可提高远期疗效，减少术后并发症、降低死亡率，对重症瓣膜病患者尤为重要。     

功能性三尖瓣关闭不全外科治疗的改进

功能性三尖瓣关闭不全主要是左心瓣膜病变引起的肺动脉高压和右心室扩大所致,三尖瓣瓣叶本身及瓣下结构没有器质性病变。目前多数学者主张在行左心瓣膜置换术的同时行三尖瓣成形术,手术方式从二瓣化成形术发展到DeVega成形术,人造瓣环成形术从二维瓣环发展到三维瓣环。本文就外科治疗功能性三尖瓣关闭不全的进展作一综述。     

功能性三尖瓣关闭不全外科治疗的改进

功能性三尖瓣关闭不全主要是左心瓣膜病变引起的肺动脉高压和右心室扩大所致,三尖瓣瓣叶本身及瓣下结构没有器质性病变.目前多数学者主张在行左心瓣膜置换术的同时行三尖瓣成形术,手术方式从二瓣化成形术发展到DeVega成形术,人造瓣环成形术从二维瓣环发展到三维瓣环.本文就外科治疗功能性三尖瓣关闭不全的进展作一综述.     

左心瓣膜置换术后孤立性三尖瓣关闭不全的外科治疗及危险因素

目的 明确左心瓣膜置换术后出现远期孤立性三尖瓣关闭不全（tricuspid regurgitation,TR）的外科治疗效果和危险因素.方法 分析2000年1月至2010年12月广东省人民医院因左心瓣膜术后发生远期孤立性重度TR而接受三尖瓣外科治疗的41例患者的资料.三尖瓣成形（tricuspid valve repair,TVP）7例,三尖瓣置换（tricuspid valve replacement,TVR）34例,比较两组的近、远期结果.并比较存活组与术后早期死亡组及术后远期死亡组的临床资料,分析手术早期及远期死亡的危险因素.结果 随访时间（6.3±3.4）年,随访率97％,死亡14例（34.1％）.TVP组术后死于右心功能衰竭1例（14.3％）,无远期死亡;因再发重度TR于术后3.5年行TVR1例.TVR组手术死亡8例,远期死亡5例,死亡率38.2％.因右心功能衰竭死亡9例,感染性心内膜炎、脑出血、猝死、结肠癌术后肝转移死亡各1例.TVP组死亡率有高于TVR组的趋势（P=0.43）.手术早期死亡组三尖瓣反流面积、肌酐值明显高于与存活组,差异有统计学意义（P＜0.05）;而术后远期死亡组右心室大小、肌酐值明显高于存活组,差异有统计学意义（P＜0.05）.结论 左心瓣膜置换术后远期孤立性TR的再次手术死亡率高,选择TVP将有助于降低死亡率.三尖瓣反流程度重、术前肌酐值升高是手术早期死亡的危险因素;右心室大小和术前肌酐值升高是术后远期死亡的危险因素.     

Complete transposition of the great arteries: surgical concepts for patients with systemic right ventricular failure following intraatrial repair

One of the most serious late complications of the intraatrial baffle procedure (Mustard or Senning correction) in patients suffering from transposition of the great arteries, (TGA) is the late systemic right ventricular failure. Nearly all patients presenting with right ventricular dysfunction have severe associated tricuspid regurgitation. The surgical options for these patients include tricuspid valve reconstruction or replacement, staged conversion to the arterial switch operation and orthotopic heart transplantation. Review of 189 operative survivors who underwent the Mustard or Senning operation for TGA between 1970 and 1993 in our institution revealed 12 patients (6.3%) who died from severe systemic right ventricular dysfunction (mean follow-up 16+/-3.5 years), which was the most common cause of late death. All of them had concomitant severe tricuspid regurgitation. 7 patients (3.7%) died from sudden cardiac death. The actuarial survival at 10 years is 93% for simple TGA and 85% for TGA associated with ventricular septum defect or coarctation. At our institution, 4 adolescent or adult patients underwent tricuspid valve surgery; tricuspid valve replacement was performed in 2 patients and valve repair in 2 patients. In the mid-term follow-up, 2 of these patients died. Two additional patients underwent orthotopic heart transplantation, and one died on the waiting list. Staged conversion from the Senning/Mustard atrial repair to the arterial switch operation was initially reported by Mee. The procedure for pulmonary artery banding starts with inducing left ventricular reconditioning with subsequent arterial switch. The mortality of this two-staged procedure was as high as 20% to 30% in our early experience, and some of the candidates underwent heart transplantation. Tricuspid valve repair or replacement do not improve right ventricular function in patients with a failing right ventricle following the Mustard/Senning operation. Staged conversion to arterial switch may improve right ventricular function by decreasing the work load of the right ventricle and provides anatomic repair with left ventricle-to-aorta continuity. Orthotopic heart transplantation is the only alternative if the left ventricle does not respond to pulmonary artery banding.     

Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients.

BACKGROUND AND AIMS OF THE STUDY: Patients with symptoms of right heart failure due to severe tricuspid regurgitation following a prior operation on left heart valves present a difficult problem. The outcome of tricuspid surgery in this setting is not well defined. We describe a single-center experience of isolated tricuspid valve surgery after prior left heart valve surgery, and analyze potential risk factors for a poor outcome. METHODS: Thirty-four patients who underwent isolated tricuspid valve operation for severe tricuspid regurgitation following prior valvular surgery for left-sided valve disease between 1980 and 1997 were identified. Charts were reviewed for clinical, echocardiographic, catheterization and surgical data. Follow up of survivors was conducted by telephone to ascertain functional status. RESULTS: Three patients died in hospital (early mortality rate, 8.8%). At a follow up of 71 +/- 39 months, 13 patients were alive and 21 reached an end-point (three cardiac reoperations, 18 deaths). Event-free actuarial survival at five years was 41.6 +/- 9.2%. Patients who were alive at follow up had a mean NYHA functional class of 2.1 +/- 0.6 compared with 3.4 +/- 0.5 preoperatively; 85% of survivors were symptomatically improved. Predictors of poor outcome were: increased age at the time of tricuspid surgery (p = 0.0007) and higher number of prior cardiac operations (one versus two or three, p-value 0.01, relative risk 3.4). Pulmonary artery systolic pressure, left ventricular ejection fraction, right ventricular function and size, annulus diameter, tricuspid valve pathology, and valve replacement versus repair were not predictive of outcome. CONCLUSIONS: Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior surgery for left-sided heart valve disease can be performed with acceptable early mortality. There remains a high late mortality that is predicted only by age and the number of previous cardiac operations. However, in this selected group of severely symptomatic patients, significant improvement in symptoms are achieved in the survivors.     

The importance of tricuspid valve structure and function in the surgical treatment of rheumatic mitral and aortic disease.

A significant proportion of individuals with rheumatic disease have tricuspid valve involvement which may be clinically important and alter the medical or surgical approach to treatment. Therefore 50 patients with rheumatic left-sided valvular lesions who were referred for operative treatment were studied. Thirty patients had angiographically significant tricuspid regurgitation (group I) and 20 had a competent tricuspid valve (group II). Pre-operative cardiac assessment included Doppler echocardiography and contrast ventriculography. Patients with tricuspid regurgitation more commonly had mitral valve disease or combined mitral and aortic valve lesions, (P less than 0.001) and were more likely to have atrial fibrillation than those without tricuspid regurgitation (P less than 0.001). Pulmonary arterial systolic and mean right atrial pressures were higher in group I (both P less than 0.01). A close relationship was found between the angiographic and Doppler assessment of the degree of tricuspid regurgitation (P less than 0.01). Doppler-derived measurement of the right ventricular-right atrial systolic pressure difference correlated well with the systolic trans-tricuspid pressure difference measured at cardiac catheterization (y = 0.7x + 22, r = 0.67, P less than 0.001) and the pulmonary arterial systolic pressure (y = 0.8x + 27, r = 0.71, P less than 0.001). Rheumatic involvement of the tricuspid valve identified by pre-operative echocardiography was confirmed in five patients at surgery. Of the 13 patients with functional tricuspid regurgitation at operation, only two had been diagnosed as having organic disease by echocardiography. Furthermore, in all 18 cases where Doppler suggested grade 3 or 4+ tricuspid regurgitation, surgical repair or replacement of the valve was performed.(ABSTRACT TRUNCATED AT 250 WORDS)     

急诊心脏瓣膜替换25例报告

目的:探讨急诊心脏瓣膜替换手术时机和围手术期处理措施。方法:1995年1月至2009年5月,对急性心脏瓣膜功能障碍致急性心肺功能衰竭施行急诊瓣膜置换25例,其中男性15例,女性10例,年龄12～64岁,术前心功能均为Ⅳ级。二尖瓣病变17例,其中二尖瓣机械瓣替换术后血栓形成致人工瓣膜功能障碍7例,人工瓣膜性心内膜炎并瓣周漏4例,感染性心内膜炎致急性二尖瓣腱索及乳头肌断裂并二尖瓣重度关闭不全5例,二尖瓣关闭不全并预激症1例。主动脉瓣病变8例,其中感染性心内膜炎并主动脉穿孔致急性心力衰竭(心衰)3例,血栓形成致人工瓣功能障碍2例,主动脉关闭不全并主动脉窦瘤破裂致急性心衰2例,外伤性主动脉瓣撕裂致主动脉瓣重度关闭不全1例。二尖瓣替换18例,其中再次心脏瓣膜替换11例,同时施行三尖瓣成形9例,异常传导束旁路切断1例。主动脉瓣替换8例。置入机械瓣22例,生物瓣3例。主动脉阻断时间34～80 min,转流时间70～160 min。结果:早期死亡1例,死于术后严重低心排综合征(低心排),其余病例术后恢复顺利,随访1～13年,心功能恢复良好。结论:及时、准确诊断,果断抉择手术时机,合理选择术式及良好围术期处理是进一步提高手术疗效的关键。     

Tricuspid and pulmonary valve disease evaluation and management

The clinical detection and quantification of tricuspid valve disease, although important, is not entirely accurate. Diagnostic evaluation is based on echocardiography, and color flow Doppler is useful for quantifying tricuspid regurgitation. Echocardiography provides information on heart chamber dimensions, right ventricular function, and the degree of pulmonary hypertension. In addition, tricuspid stenosis can be accurately assessed using mean and end-diastolic pressure gradient measurements. The treatment options for tricuspid stenosis include balloon valvuloplasty and surgical valve repair. Functional tricuspid regurgitation associated with left heart disease may require surgical attention during an operation to treat the left heart disease. Severe tricuspid regurgitation usually requires surgery to be performed in association with mitral valve surgery. Mild-to-moderate tricuspid regurgitation requires surgery when annular dilatation or severe pulmonary hypertension is present. The surgical options include tricuspid valve repair, with or without an annuloplasty ring. In patients with a primary anatomic deformity of the tricuspid valve, replacement of the valve with a bioprosthesis or mechanical valve may be considered. Intermediate and long-term results favor annuloplasty valve repair over valve replacement. Pulmonary valve disease is predominantly congenital, and generally takes the form of pulmonary stenosis. Pulmonary regurgitation often results from surgical or balloon valvuloplasty and is associated with deleterious long-term sequelae. The recent development of percutaneous valve replacement was a major advance.     

Surgical treatment of late tricuspid regurgitation after left cardiac valve replacement

BACKGROUND: The development of late tricuspid regurgitation (TR) following left cardiac valve replacement is an important complication, as it is associated with a severe impairment of exercise capacity and a poor symptomatic outcome. The pathogenesis of this condition remains poorly defined. It is still a challenge in terms of its prevention, treatment and indications for surgical correction. AIMS: To investigate the possible pathogenesis and report the surgical results of the late TR after left cardiac valve replacement. METHODS: There were 56 patients with moderate to severe TR after left cardiac valve replacement, divided into normal prosthesis group (10 patients with normal prosthetic valve function) and dysfunctional prosthesis group (46 patients with prosthetic valve dysfunction). In the normal prosthesis group, 4 patients underwent mitral valve replacement (MVR) and 6 patients underwent combined mitral and aortic valve replacement (DVR). Patients in the dysfunctional prosthesis group included MVR in 36, aortic valve replacement (AVR) in 4 and DVR in 6, with bioprosthetic valve dysfunction occurring in 18, mechanical prosthetic valve obstruction in 22 and periprosthetic valve leakage in 6 patients. At the initial operation, 10 patients underwent DeVega's tricuspid annuloplasty and 46 patients' tricuspid valves were normal. At the second operation, the surgical treatment of TR included tricuspid valve replacement (TVR) in 9 and tricuspid annuloplasty in 47. RESULTS: Two patients died postoperatively giving a 3.6% hospital mortality. The 54 survivors were followed up for 6-132 months (mean of 79.4 months). Heart function improved significantly in 8 with TVR and in 40 with tricuspid annuloplasty. Echocardiography showed moderate TR in 5 and severe TR in 1 patient with tricuspid annuloplasty who need a further surgical treatment. CONCLUSION: Pulmonary hypertension, myocardial dysfunction, and atrial fibrillation might be responsible for the development of late TR after left cardiac valve replacement. Tricuspid annuloplasty, as the surgical method of first choice, resulted in improvement in 87% of patients with late TR after left cardiac valve replacement. TVR can also be safely applied to repair organic disease and the extremely dilated tricuspid valve annulus. If the TR area is more than 25cm(2), the TVR is recommended.     

Comparison of Doppler echocardiography and cardiac catheterization in patients requiring valve surgery: search for a 'gold standard'.

OBJECTIVE: To compare the sensitivities of Doppler echocardiography and cardiac catheterization in the diagnosis of severe valvular heart disease in patients requiring valve surgery. DESIGN: Retrospective analysis of Doppler echocardiograms and cardiac catheterizations. SETTING: Tertiary referral cardiovascular centre in a university setting. PATIENTS: Sixty-nine patients undergoing valve surgery between July 1988 and July 1990. RESULTS: The sensitivities of echocardiography and cardiac catheterization were 84 and 87%, respectively (P = 1.0) in 32 patients who underwent aortic valve surgery primarily for severe aortic stenosis; 83 and 67%, respectively (P = 1.0) in six patients with severe aortic regurgitation, and 100 and 85%, respectively (P = 1.0) in seven patients with combined severe aortic stenosis and regurgitation. The sensitivities of echocardiography and cardiac catheterization in 11 patients who underwent mitral valve surgery for severe mitral stenosis were 73 and 91%, respectively (P = 0.6) and 69 and 92%, respectively (P = 0.3) in 13 patients with severe mitral regurgitation. Sensitivities of echocardiography and cardiac catheterization in the diagnosis of severe tricuspid regurgitation in five patients who had tricuspid valve repair were 100 and 80%, respectively (P = 1.0). Two patients with severe aortic stenosis by echocardiography, but not by catheterization, did not undergo aortic valve replacement during valvular surgery; both required aortic valve replacement within two years of initial surgery because of heart failure. Four patients with severe tricuspid regurgitation identified by echocardiography did not have tricuspid repair; three had pulmonary hypertension and these patients had resolution of tricuspid regurgitation on follow-up. One patient with severe tricuspid regurgitation and absence of pulmonary hypertension required reoperation for tricuspid valve repair 10 months after initial operation. CONCLUSIONS: The sensitivity of echocardiography and cardiac catheterization in the detection of severe valvular lesions requiring surgery is similar. Discordant results should be reviewed carefully with knowledge of the inherent pitfalls of both techniques in order to ensure optimal patient outcome.     

Tricuspid valve replacement after cardiac transplantation

PURPOSE OF REVIEW: Tricuspid valve regurgitation is the most frequent valvular complication following orthotopic cardiac transplantation. It leads to diminished quality of life and predicts shortened long-term survival. The optimal surgical management of refractory tricuspid valve regurgitation in this setting is unclear. RECENT FINDINGS: Tricuspid valve regurgitation following cardiac transplantation is likely related to accumulated injury from repeated endomyocardial biopsies. Durability of repair in this setting was shown to be suboptimal. Replacement with a bioprosthesis was found to be durable and relieves symptoms of heart failure associated with tricuspid valve regurgitation in the majority of patients. Prophylactic tricuspid valve annuloplasty at transplantation was found to significantly decrease the incidence of early and late tricuspid valve regurgitation; long-term benefits remain unclear. SUMMARY: Results of tricuspid valve repair in the post-cardiac transplant setting are not ideal, and this strategy is better suited to treating functional tricuspid valve regurgitation resulting from annular dilatation. Tricuspid valve replacement with a bioprosthesis is a safe, durable, and effective method of treating tricuspid valve regurgitation following transplantation and allows for future endomyocardial biopsies to be performed. Mechanical valves should be avoided. A randomized controlled trial examining the long-term outcomes of prophylactic tricuspid annuloplasty is warranted.