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Editorial
Intervening for tricuspid regurgitation: uncertainties in a heterogeneous syndrome
  1. Yogesh N V Reddy,
  2. Rick Nishimura
  1. Department of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Rick Nishimura, Cardiovascular Disease, Mayo Clinic, Rochester, MN 55905, USA; rnishimura{at}mayo.edu

https://doi.org/10.1136/heartjnl-2019-315624

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    Tricuspid regurgitation (TR) is one of the most common valvular heart lesions encountered in clinical practice. It has now been unequivocally established that the presence of worsening TR is associated with poor outcomes.1 In the past, intervention for severe TR has been infrequently performed due to the lack of prospective data supporting an improvement in outcomes as well as a high reported operative mortality (up to 8%–20%).2 This has resulted in the current practice pattern where patients with severe TR are typically managed conservatively and often referred for surgery only after the onset of diuretic refractory right heart failure and end-organ damage with renal failure and hepatic cirrhosis. However, there is now a renewed interest in the management of patients with TR due to: (1) an increasing number of patients presenting with right heart failure from TR, (2) advanced surgical techniques resulting in a lower operative risk3 with documented improvement in symptoms4 5 and (3) the development of catheter-based therapies for this valve disease.

    Summary of current study

    In their Heart paper, Kadri et al6 report on the surgical experience for severe TR from the Cleveland Clinic over a 1year period from 2011 to 2012 and provide a signal that there may be a mortality benefit of operation for severe TR. A total of 534 patients were identified with severe TR and heart failure. The predominant mechanism of TR was functional, and this was reflected in a high prevalence of risk factors for secondary TR including annular dilation and atrial fibrillation (74%), a low ejection fraction or left sided valve disease (75%), significant mitral disease (70%), pulmonary hypertension (80%) or Right ventricular (RV) dysfunction (77%). Only 55 (~10%) patients …

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    Footnotes

    • Contributors Both authors contributed to the manuscript preparation and revision.

    • 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 Commissioned; internally peer reviewed.

    Linked Articles

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      Outcomes of patients with severe tricuspid regurgitation and congestive heart failure
      Amer N Kadri Vivek Menon Yasser M Sammour Rama D Gajulapalli Chandramohan Meenakshisundaram Leen Nusairat Divyanshu Mohananey Adrian V Hernandez Jose Navia Amar Krishnaswamy Brian Griffin Leonardo Rodriguez Serge C Harb Samir Kapadia
      Heart 2019; 105 1813-1817 Published Online First: 17 Aug 2019. doi: 10.1136/heartjnl-2019-315004