What is it? Mitral/tricuspid valve repair

About mitral/tricuspid valve repair

Your heart is about the size of your fist and located between your lungs in the area called the “mediastinum.” The normal heart has four pumping chambers (two atria — a right and a left atrium, and two ventricles — a right and a left ventricle). The normal heart has four valves. On the right side of the heart, the tricuspid valve is located between the right atrium and right ventricle and a pulmonary valve is located between the right ventricle and the lungs. On the left side of the heart, the mitral valve is between the left atrium and the left ventricle. Blood that is pumped out of the heart by the left ventricle passes through the aortic valve and enters the aorta (and to the rest of the body). It’s the heart’s continuous pumping action (contracting) that keeps your body supplied with oxygen-rich blood.

Heart valves are made up of tissue and this tissue forms the leaflets, which open and close during the cardiac cycle, allowing blood to move between the chambers. When they are functioning properly, they work with the heart to continuously pump blood during rest and during exercise. The tricuspid valve, the pulmonary valve, and the aortic valve all typically have three leaflets; the mitral valve has two. The mitral valve and tricuspid valves have chords (chordae tendineae) that help control the movement of the valve leaflets. The area of the heart where valve leaflets are attached is a thicker, fibrous, tissue called the valve annulus.

Sometimes the valve leaflets become damaged and fail to close completely. When this happens, some of the blood can leak backwards instead of going forward. This valve condition impairs the heart’s ability to pump the necessary amount of blood to the rest of the body.

If mitral/tricuspid valve repair is an option for a patient, the surgeon may need to reshape their mitral or tricuspid valve. This is called an annuloplasty procedure. During an annuloplasty, the surgeon may also need to repair the leaflet tissue, remove calcium deposits, or repair the tough chords that control movement of the mitral and tricuspid valve leaflets.

For surgical mitral/tricuspid valve repair, one or more of the following procedures is done:

  • Reshaping of the valve by removing excess valve tissue.
  • Attaching the valve to its chords.
  • Adding support to the valve annulus by adding tissue or by sewing a band or ring around the outside of the valve.

Some patients may feel physically better following valve surgery because they are no longer impacted by the symptoms of their valve disease.

Since each patient has a unique medical history, mitral/tricuspid repair may not be a suitable option for every patient. Depending on the patient, valve replacement, medical management, transcatheter repair, or other treatment strategies may be appropriate. Consult your doctor to discuss the best treatment option for you and also potential risks such as recurrent regurgitation, stenosis, or ring/band dehiscence.

Risks for mitral valve surgery do exist, as they do for all cardiac surgery operations, and complications may occur. Although not frequent, death, stroke, permanent pacemaker implantation, and other adverse events may occur. It is important to talk to your doctor about the risks of all therapy options.

Valve repair with an annuloplasty ring or band

An annuloplasty ring or band is made up of plastic, metal, and fabric. It may be rigid, semi-rigid, or flexible. Rings and bands are designed to maintain the natural shape, motion, and flexibility of the patient's mitral or tricuspid annulus. The rings or bands may also contain a radiopaque marker that makes it possible for the healthcare professional to see them on an X-ray.

CG Future annuloplasty system

The semi-rigid CG Future™ annuloplasty system is used to restore the annulus to its proper dimensions.1,2

CG Future™ annuloplasty ring and band shown side-by-side

Contour 3D annuloplasty ring

The Contour 3D™ ring is designed to resemble the natural shape of the tricuspid annulus and restore the dimensions of a diseased annulus.3

Contour 3D™ ring

Duran AnCore annuloplasty system

The Duran AnCore™ annuloplasty system is used to provide shape and stability to the valve annulus.

Duran AnCore™ ring and band

Profile 3D annuloplasty system

The Profile 3D™ annuloplasty system uses fully rigid rings to repair the mitral valve annulus, restoring the valve to its natural shape.4,5

Profile 3D™ ring

SimuForm semi-rigid annuloplasty ring

The SimuForm™ ring is a semi-rigid solution for mitral valve repair.

SimuForm™ annuloplasty ring shown from the side

SimuPlus flexible annuloplasty ring and band

The SimuPlus™ ring and band are used for mitral valve repair or tricuspid valve repair (band only).

SimuPlus™ ring and band

Tri-Ad 2.0 Adams tricuspid annuloplasty band

The Tri-Ad™ 2.0 Adams tricuspid band provides flexible remodeling — the band's arms are flexible, while semi-rigid remodeling is targeted at the annular dilatation.

Tri-Ad™ 2.0 Adams band

See benefits and risks to mitral/tricuspid valve repair

1. Sharony R, Saunders P, Nayar A, et al. Semirigid partial annuloplasty band allows dynamic mitral annular motion and minimizes valvular gradients: an echocardiographic study. Ann Thorac Surg. 2004;77(2):518–522.

2. Lange R, Guenther T, Kiefer B, et al. Mitral valve repair with the new semirigid partial Colvin-Galloway Future annuloplasty band. J Thorac Cardiovasc Surg. 2008;135(5):1087–1093.

3. Ratschiller T, Guenther T, Guenzinger R, et al. Early experiences with a new three-dimensional annuloplasty ring for the treatment of functional tricuspid regurgitation. Ann Thorac Surg. 2014;98(6):2039–2044.

4. Sideris K, Boehm J, Voss B, Guenther T, Lange RS, Guenzinger R. Functional and degenerative mitral regurgitation: One ring fits all? Thorac Cardiovasc Surg. 2020;68(6):470–477.

5. Guenzinger R, Guenther T, Ratschiller T, et al. Is a profiled annuloplasty ring suitable for patients with degenerative mitral regurgitation? A single-center experience comprising 200 patients. Thorac Cardiovasc Surg. 2016;64(5):434–440.