**2. Current clinical guidelines on the management of tricuspid valve diseases**

In spite of clinical significance of early surgery, TV interventions are often initiated too late [10, 11]. Appropriate timing of tricuspid surgery is essential to avoid irreversible right ventricle (RV) dysfunction with subsequent increased surgical risk [12, 13]. Not only have clinical and diagnostic thresholds been defined but also there is inconclusive data for prognostic value of tricuspid annular pulmonary systolic excursion in patients with primary TR undergoing surgical intervention. Clinical importance of tricuspid annulus plane systolic excursion (TAPSE) and RV reverse remodeling have been highlighted predominantly in secondary tricuspid valve regurgitation studies [14, 15].

#### **2.1 Indication for tricuspid valve intervention and prosthesis choice**

Regarding severe primary TR, recent guidelines recommend surgical intervention in symptomatic patients. In selected asymptomatic or mildly symptomatic patients who are appropriate for surgery, an intervention should also be considered when RV dilatation or declining RV function is observed.

Whenever possible, annuloplasty with prosthetic rings is preferable to valve replacement, which should only be considered when the tricuspid valve leaflets are tethered and the annulus severely dilated [14, 16]. In the presence of a cardiac implantable electronic device lead, the technique used should be adapted to the patient's condition and the surgeon's experience [17].

*Contemporary Approach with Mitral Valve Allograft in the Treatment of Tricuspid Valve… DOI: http://dx.doi.org/10.5772/intechopen.111687*

TVR procedure accounts for less than 10% of all interventions on the tricuspid valve [18, 19].

Replacement of the tricuspid valve is a necessary measure in cases where annuloplasty is not possible (infective endocarditis, Ebstein's anomaly, reoperation after unsuccessful plastic surgery, prosthetic endocarditis) [19].

Mechanical valves are considered better durability, but higher risk of thrombosis, bleeding complication due to anticoagulation and decreased turbulence [19–21].

Biological prostheses do not require long-term anticoagulants and have a lower risk of hemorrhagic events, but at the same time durability is limited as a result of structural valve deterioration [16].

There are no specific guidelines devoted to a type of prosthetic valve that would be the best choice in the tricuspid position [22].

One meta-analysis strongly indicates the risk of thrombosis in mechanical valves is higher, while other end-points are not significantly different between the two types of valves [6].

Transcatheter tricuspid valve interventions may be considered by the Heart Team at experienced Heart Valve Centers in symptomatic, inoperable, and anatomically eligible patients in whom symptomatic or prognostic improvement can be expected. For detailed anatomical evaluation, transesophageal (TOE) echocardiography (ECHO) and cardiac computed tomography may be preferred owing to higher spatial resolution [23, 24].
