Tricuspid Regurgitation (TR)

 

 

Considerations 

 

  • ↑ risk of perioperative cardiovascular complications 

  • Hemodynamic consequences:

    • Mild-moderate usually well tolerated with little consequence 

    • Severe TR may result in RV pressure/volume overload ➝ RV dysfunction, hepatomegaly, ascites, peripheral edema, cardiorenal syndrome

  • Medication management 

  • Management of any comorbid diseases (e.g. pulmonary hypertension, endocarditis, carcinoid, rheumatic heart disease) 

 

 

Anesthetic Goals 

 

  • Preload: normal to ↑, critical to avoid hypovolemia  

  • Rate: normal to high to sustain forward flow   

  • Rhythm: sinus  

  • Contractility: RV may need inotropic support if RV failure  

  • Afterload: maintain  

  • PVR: avoid any ↑ (avoid high airway pressures, hypercarbia, hypoxemia, hypothermia, acidosis) 

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