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Original research
Determinants of clinical outcomes of surgery for isolated severe tricuspid regurgitation
  1. Sung Jun Park1,
  2. Jin Kyung Oh2,
  3. Seon-Ok Kim3,
  4. Seung-Ah Lee4,
  5. Ho Jin Kim1,
  6. Sahmin Lee4,
  7. Sung Ho Jung1,
  8. Jong-Min Song4,
  9. Suk Jung Choo1,
  10. Duk-Hyun Kang4,
  11. Cheol Hyun Chung1,
  12. Jae-Kwan Song4,
  13. Jae Won Lee1,
  14. Dae-Hee Kim4,
  15. Joon Bum Kim1
  1. 1 Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, The Republic of Korea
  2. 2 Cardiology, Chungnam National University Sejong Hospital, Sejong, The Republic of Korea
  3. 3 Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Songpa-gu, The Republic of Korea
  4. 4 Division of Cardiology, Asan Medical Center, Seoul, The Republic of Korea
  1. Correspondence to Dr Joon Bum Kim, Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul 05505, Korea (the Republic of); jbkim1975{at}; Dr Dae-Hee Kim, Division of Cardiology, Asan Medical Center, Seoul, The Republic of Korea; daehee74{at}


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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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