Tricuspid valve repair is relatively uncommon compared to surgery on other heart valves. In the United States, roughly 2,100 isolated tricuspid operations were performed in 2019, up from about 980 in 2012. That’s a small fraction of the tens of thousands of aortic and mitral valve procedures done each year. Still, the number is growing steadily, and newer catheter-based techniques are expanding who can be treated.
How Procedure Volume Has Changed
Isolated tricuspid operations (meaning the tricuspid valve is the only valve being operated on) more than doubled between 2012 and 2019, according to the Society of Thoracic Surgeons database. That jump from 983 to 2,155 annual cases reflects a broader shift: doctors are recognizing that significant tricuspid valve leaking deserves its own treatment rather than a wait-and-see approach.
Even so, most tricuspid valve work still happens alongside surgery on another valve. Only about 23% of tricuspid procedures are isolated. The remaining 77% are concomitant, meaning the surgeon addresses the tricuspid valve while already operating on the mitral or aortic valve. This is partly why tricuspid disease has historically been called the “forgotten valve.” It was often treated as an afterthought during left-sided heart surgery rather than as a standalone problem.
Repair vs. Replacement
When surgeons do operate on the tricuspid valve in isolation, the split between repair and full replacement is surprisingly close to 50/50. A large national analysis found that 50.8% of isolated tricuspid operations were repairs, while 49.2% were replacements. A separate meta-analysis covering over 15,000 patients found the repair rate was closer to 45%. Either way, repair is used in roughly half of cases.
That ratio is lower than what surgeons achieve with the mitral valve, where repair is strongly preferred. The tricuspid valve’s anatomy and the advanced disease stage at which most patients finally reach surgery make repair more technically difficult. Guidelines suggest that repair rates should be pushed higher where possible, and that patients needing tricuspid surgery benefit from being treated at experienced, high-volume centers.
Who Typically Needs Tricuspid Surgery
The typical patient undergoing tricuspid valve surgery is in their late 50s, with a median age of 57 in one large series. Women make up about 55% of cases. Most patients have secondary tricuspid regurgitation, meaning the valve itself isn’t diseased but has stretched out of shape because of conditions like heart failure, atrial fibrillation, or pulmonary hypertension that enlarge the right side of the heart. A smaller group has primary valve damage from infections, trauma, or congenital problems.
Current ACC/AHA guidelines recommend surgery for patients with severe tricuspid regurgitation who have symptoms like swelling, fatigue, or fluid buildup, ideally before the right side of the heart weakens significantly or organs like the liver and kidneys start showing damage. Surgery can also be considered for patients with progressive (not yet severe) leaking if they’re already undergoing left-sided valve surgery.
Catheter-Based Repair Is Gaining Ground
A newer option is transcatheter edge-to-edge repair, a minimally invasive procedure where a small clip is delivered through a vein to reduce valve leaking without open-heart surgery. The TRILUMINATE trial, which randomized 572 patients across 68 centers in five countries, showed strong results at two years. Patients who received the clip plus medication had significantly better outcomes than those on medication alone. In fact, 59% of patients initially assigned to medication alone chose to cross over and receive the clip after their first year, a striking indicator of how much benefit patients perceived.
Catheter-based procedures also carry considerably lower immediate risk. The pooled in-hospital mortality for percutaneous tricuspid repair is around 1.2%, compared to 7.7% for open surgery. This safety advantage is particularly meaningful because many patients with severe tricuspid regurgitation are older or too sick for traditional surgery, which is one reason the valve has been undertreated for decades.
Surgical Risk and Recovery
Open tricuspid surgery carries real risk. The overall in-hospital mortality for isolated tricuspid operations is approximately 7 to 8%, which is notably higher than mortality rates for isolated mitral or aortic valve surgery. The most common complication is needing a permanent pacemaker afterward, reported in anywhere from 4% to 22% of patients depending on the study and procedure type. The wide range reflects differences in surgical technique and whether the operation is a repair or replacement.
Recovery from open tricuspid surgery typically involves about five days in the hospital. Most people return to normal activities three to four months after surgery. Catheter-based procedures generally involve shorter hospital stays and faster recovery, though long-term follow-up data is still accumulating as these techniques are relatively new.
Why It Remains Underperformed
Despite growing volumes, tricuspid surgery is still performed far less often than the number of patients with significant tricuspid regurgitation would suggest. Several factors explain the gap. The condition develops gradually, and symptoms like swelling and fatigue overlap with other common problems, so it often goes undiagnosed until it’s advanced. Historically high surgical mortality made doctors hesitant to refer patients. And because many patients are elderly with multiple health problems, they were deemed too high-risk for open surgery before catheter-based options existed.
The combination of rising awareness, clearer guidelines, and new minimally invasive tools is changing this picture. Procedure volumes have been climbing year over year, and the availability of transcatheter repair is expected to make treatment accessible to a much larger group of patients who previously had no good options.