RT Journal Article
SR Electronic
T1 Isolated tricuspid regurgitation: outcomes and therapeutic interventions
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 798
OP 806
DO 10.1136/heartjnl-2017-311586
VO 104
IS 10
A1 Erin A Fender
A1 Chad J Zack
A1 Rick A Nishimura
YR 2018
UL http://heart.bmj.com/content/104/10/798.abstract
AB Isolated tricuspid regurgitation (TR) can be caused by primary valvular abnormalities such as flail leaflet or secondary annular dilation as is seen in atrial fibrillation, pulmonary hypertension and left heart disease. There is an increasing recognition of a subgroup of patients with isolated TR in the absence of other associated cardiac abnormalities. Left untreated isolated TR significantly worsens survival. Stand-alone surgery for isolated TR is rarely performed due to an average operative mortality of 8%–10% and a paucity of data demonstrating improved survival. When surgery is performed, valve repair may be preferred over replacement; however, there is a risk of significant recurrent regurgitation after repair. Existing society guidelines do not fully address the management of isolated TR. We propose that patients at low operative risk with symptomatic severe isolated TR and no reversible cause undergo surgery prior to the onset of right ventricular dysfunction and end-organ damage. For patients at increased surgical risk novel percutaneous interventions may offer an alternative treatment but further research is needed. Significant knowledge gaps remain and future research is needed to define operative outcomes and provide comparative data for medical and surgical therapy.