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Original research article
Outcomes of patients with severe tricuspid regurgitation and congestive heart failure
  1. Amer N Kadri1,
  2. Vivek Menon1,
  3. Yasser M Sammour2,
  4. Rama D Gajulapalli1,
  5. Chandramohan Meenakshisundaram1,
  6. Leen Nusairat1,
  7. Divyanshu Mohananey1,
  8. Adrian V Hernandez3,4,
  9. Jose Navia5,
  10. Amar Krishnaswamy2,
  11. Brian Griffin2,
  12. Leonardo Rodriguez2,
  13. Serge C Harb2,
  14. Samir Kapadia2
  1. 1 Medicine Institute, Cleveland Clinic, Cleveland, Ohio, United States
  2. 2 Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
  3. 3 Evidence-based Practice Center, University of Connecticut / Hartford Hospital, Hartford, Connecticut, United States
  4. 4 School of Medicine, Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru
  5. 5 Department of Cardiothoracic Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, United States
  1. Correspondence to Dr Samir Kapadia, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; kapadis{at}


Objectives A substantial number of patients with severe tricuspid regurgitation (TR) and congestive heart failure (CHF) are medically managed without undergoing corrective surgery. We sought to assess the characteristics and outcomes of CHF patients who underwent tricuspid valve surgery (TVS), compared with those who did not.

Methods Retrospective observational study involving 2556 consecutive patients with severe TR from the Cleveland Clinic Echocardiographic Database. Cardiac transplant patients or those without CHF were excluded. Survival difference between patients who were medically managed versus those who underwent TVS was compared using Kaplan-Meier survival curves. Multivariate analysis was performed to identify variables associated with poor outcomes.

Results Among a total of 534 patients with severe TR and CHF, only 55 (10.3%) patients underwent TVS. Among the non-surgical patients (n=479), 30% (n=143) had an identifiable indication for TVS. At 38 months, patients who underwent TVS had better survival than those who were medically managed (62% vs 35%; p<0.001). On multivariate analysis, advancing age (HR: 1.23; 95% CI 1.12 to 1.35 per 10-year increase in age), moderate (HR: 1.39; 95% CI 1.01 to 1.90) and severe (HR: 2; 95% CI 1.40 to 2.80) right ventricular dysfunction were associated with higher mortality. TVS was associated with lower mortality (HR: 0.44; 95% CI 0.27 to 0.71).

Conclusion Although corrective TVS is associated with better outcomes in patients with severe TR and CHF, a substantial number of them continue to be medically managed. However, since the reasons for patients not being referred to surgery could not be ascertained, further randomised studies are needed to validate our findings before clinicians can consider surgical referral for these patients.

  • heart failure
  • valvular heart disease
  • tricuspid regurgitation

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  • Contributors AK, VM, YMS, RDG, LN, AH, DM and CM were all involved in the conception, design, analysis and interpretation of the data. AK, RDG, JN, AK, BG, LR, SCH and SK were involved in drafting of the manuscript and revising it critically for important intellectual content. SK made the final approval of the manuscript. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of this work will be appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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