Tricuspid valve regurgitation: its interplay with the right ventricle, prognostic role, and surgical results in various settings

This thesis deals with surgery for tricuspid regurgitation, a valve in the right heart that separates the atrium from the ventricle. Like all valves, the tricuspid imposes a unidirectional pathway on the blood that prevents it from flowing back from the ventricle to the right atrium. When this condition occurs, it is called tricuspid regurgitation. The causes under this condition can be multiple, but the two most common are: 1) tricuspid regurgitation due to atrial and ventricle dilatation, often as consequence of left heart valve or myocardium disease; 2) valve infection, as in patients having a pacemaker, or on dialysis or intravenous drugs addicts. Surgery is the main approach when regurgitation becomes significant, but even today there are unresolved topics such as the sub-optimal outcome of surgery in some cases. This thesis has dealt to highlight the need to intervene earlier in some particular groups of patients, and to evaluate those risk factors that could predict a failure, inducing thus the surgeon to change surgical strategy. In a few words, this thesis I tries to outline the profile of patients with tricuspid regurgitation in order to suggest a more patient-centric strategy, rather than simply a technical-centric one.