Objectives Although the incidence of patients with isolated tricuspid regurgitation (TR) is increasing, data regarding the clinical outcomes of isolated TR surgery are limited. This study sought to investigate the prognostic implications according to procedural types, and to identify preoperative predictors of clinical outcomes after isolated TR surgery.
Methods Among consecutive 2610 patients receiving tricuspid valve (TV) procedure, we analysed 238 patients (age, 59.6 years; 143 females) who underwent stand-alone TV surgery (repair, 132; replacement, 106) for severe TR. Primary outcome was the composite of all-cause mortality and heart transplantation. Clinical outcomes between the repair and the replacement groups were compared after adjusting with the inverse probability of treatment weighting (IPTW) method.
Results During follow-up (median, 4.1 years), 53 patients died and 4 received heart transplantation. Multivariable analysis revealed that age (p=0.001), haemoglobin level (p=0.003), total bilirubin (p=0.040), TR jet area (p=0.005) and right atrial (RA) pressure (p=0.022) were independent predictors of the primary outcome. After IPTW adjustment, there were no significant intergroup differences in the risk of primary outcome (HR 1.01; 95% CI 0.55 to 1.87). In the subgroup analysis, tricuspid annular diameter was identified as a significant effect modifier (p=0.012) in the comparison between repair versus replacement, showing a trend favouring replacement in patients with annular diameter >44 mm.
Conclusions The outcomes of stand-alone severe TR surgery were independently associated with the severity of TR and RA pressure. In selected patients with severe annular dilation >44 mm, replacement may become a feasible option.
- tricuspid valve disease
- valve disease surgery
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SJP and JKO contributed equally.
D-HK and JBK contributed equally.
Correction notice This article has been corrected since it was published Online First. Dae-Hee Kim has been added as a corresponding author and the equally contribution statement has been linked to authors Dae-Hee Kim and Joon Bum Kim.
Contributors Study concept and design: SJP, JKO, D-HK, JBK. Data acquisition and outcome measure: S-AL, HJK, SL, S-HJ, J-MS, SJC, D-HK, CHC. Data analysis and interpretation: SOK. Manuscript drafting: JKO. Critical review and revision: SJP, JKO, D-HK, JBK, J-KS, JWL. Approval of final version: D-HK, JBK.
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.
Ethics approval The study protocol was approved by the Asan Medical Center Institutional Review Board (2020–0718) and all patients provided written informed consent. Research was performed in accordance with the Declaration of Helsinki.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request.
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