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Original research article
Characteristics and treatment strategies for severe tricuspid regurgitation
  1. Brenden S Ingraham,
  2. Sorin V Pislaru,
  3. Vuyisile T Nkomo,
  4. Rick A Nishimura,
  5. John M Stulak,
  6. Joseph A Dearani,
  7. Charanjit S Rihal,
  8. Mackram F Eleid
  1. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Mackram F Eleid, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA; Eleid.Mackram{at}Mayo.edu

Abstract

Objective This study aimed to identify characteristics, spectrum of tricuspid regurgitation (TR) severity and treatment patterns in patients considered for intervention of severe TR at a tertiary centre. The population being considered for TR intervention is currently not well defined and the role of transcatheter interventions is unclear.

Methods The study involved 87 patients with severe TR considered for intervention from 1 March 2016 to 12 November 2018 at Mayo Clinic. Patients receiving medications alone were compared with those receiving intervention to identify patterns in demographics, clinical/echocardiographic associations and survival.

Results Mean age was 80±9 (56% female), 93% had atrial fibrillation and 64% had chronic kidney disease ≥3 a. Follow-up was 331±276 days; 95% were symptomatic with 6 min walk distance of 270±110 m. Loop diuretics were used in 93%; aldosterone antagonists in 35%. Mean tricuspid annular plane systolic excursion was 15.6±3.8 mm, effective regurgitant orifice area (EROA) 82±32 mm2 and stroke volume index 39±11 mL/m2; 48% had at least moderate right ventricular (RV) dysfunction, and 75% did not undergo intervention. Patients receiving intervention showed trends towards larger EROA (93±33 vs 75±31 mm2), better right ventricular function and more severe symptoms. Overall group 30-day and 1-year survival were 100% and 76%, respectively.

Conclusions Patients with severe TR considered for intervention are commonly elderly with atrial fibrillation, advanced TR and RV dysfunction; 75% were treated with medications alone and not offered intervention. Patients with greater EROA, better RV function and more severe symptoms were more likely to receive intervention. These findings have implications for future trial design.

  • tricuspid regurgitation
  • transcatheter intervention
  • TVR
  • minimally invasive
  • device

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Footnotes

  • Contributors BSI and MFE primarily planned and wrote this manuscript. They selected patients, collected and analysed the data and composed the manuscript, tables and figures presented. The other listed authors provided significant contributions to the project drawing from their expertise within their respective fields. Each of the listed authors has contributed significantly to this manuscript’s conception, and no conflict of interest—financial or otherwise—is known to exist between any of the authors and the content presented within the submitted manuscript.

  • Funding This work was supported by the Department of Cardiovascular Medicine, Mayo Clinic.

  • Competing interests None declared.

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

  • Patient consent for publication Not required.

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