Isolated tricuspid valve surgery is rare and few studies have examined outcomes in this population. Studies are often heterogeneous, and include both primary and secondary tricuspid valve disease
| Author, year | Study design | Study population | Outcomes | Comments and limitations | |
| Isolated primary tricuspid regurgitation | Mangoni et al, 200131 | Single-centre, retrospective cohort study from 1988 to 1996 | 15 patients with TV replacement for rheumatic disease (n=12), healed endocarditis (n=2) and sarcoidosis (n=1) Mean age: 61 years Bioprosthetic valve: 33% Mechanical valve: 67% | 30-day mortality: 20% Median survival 1.2 years Short-term mortality highest in those with anasarca Long-term mortality highest in those with anaemia, rheumatic disease, previous stroke or previous mitral valve surgery | Included patients with tricuspid stenosis (n=1), regurgitation (n=8) and mixed stenosis and regurgitation (n=6) No comparison to medical therapy |
| Attenhofer et al, 201245 | Single-centre, retrospective cohort study from 1980 to 2010 | 81 adult patients >50 years of age with severe TR due to Ebstein’s anomaly Mean age: 59 years TV repair: 25% Bioprosthetic valve: 52% Mechanical valve: 23% Previous cardiac surgery: 16% | In-hospital mortality: 4% (all prior to 1995) At 84 months’ follow-up, death occurred in 17% and improved NYHA functional class in 89%. | Included patients with Ebstein’s anomaly only No comparison to medical therapy | |
| Messika-Zeitoun et al, 200419 | Single-centre, retrospective cohort from 1980 to 2000 | 60 patients with TV flail, of whom 33 underwent isolated surgery Mean age: 51 years TV repair: 82% Bioprosthetic valve: 12% Mechanical valve: 6% | In-hospital mortality: 3% (n=1) Symptomatic improvement in 88% of surgical patients | Long-term survival for surgical versus medical patients is not reported. Combined CABG or AVR performed in three patients | |
| Isolated secondary tricuspid regurgitation | Kwon et al, 200646 | Single-centre, prospective cohort study from 2003 to 2005 | 18 patients with symptomatic secondary TR following previous mitral valve surgery Mean age: 58 years TV repair: 33% TV replacement: 67% | In-hospital mortality: 11% (n=2) Improved NYHA functional class or 25% increase in respiratory variation of the inferior vena cava in 56% of survivors (n=9) Adverse outcomes predicted by TV annular systolic velocity <9.5 cm/s | Outcome was a combined end-point of improved NYHA functional class or increased respiratory variation in the inferior vena cava. No comparison to medical therapy |
| Mixed population primary and secondary tricuspid regurgitation | Topilsky et al, 201138 | Single-centre, retrospective cohort study from 1997 to 2007 | 189 patients with TV replacement for symptomatic severe TR Mean age: 67.5 years Isolated TV surgery: 36% Secondary TR: 29% Combined MV or AV surgery: 46.5% Combined CABG: 26.5% Previous left-sided valve surgery: 46.5% Bioprosthetic replacement: 81.5% Mechanical replacement: 18.5% | Overall in-hospital mortality for all surgeries: 10% In-hospital mortality for isolated surgery: 6% At 29 months’ follow-up, death occurred in 37% and heart failure admission in 21.7%. All-cause mortality was associated with increased Charlson comorbidity index score, shorter right index of myocardial performance and NYHA class IV symptoms. | 46.5% of the study population had combined MV or AV surgery. Unclear how many isolated operations were performed for primary versus secondary TR No comparison to medical therapy Excluded TV repairs |
| Kim et al, 200940 | Single-centre, prospective cohort study from 2003 to 2008 | 61 patients with symptomatic TR Mean age: 57 years Secondary TR: 84% Previous left-sided valve surgery: 93% TV repair: 13% Bioprosthetic replacement: 49% Mechanical replacement: 38% | In-hospital mortality 9.8% At 32 months’ follow-up, cardiac death occurred in three patients and six had cardiac readmissions. | Unclear how many events occurred in patients with primary versus secondary TR No comparison to medical therapy | |
| Vassileva et al, 20121 | Multicentre claims data from the Nationwide Inpatient Sample from 1999 to 2008 | 5736 patients with isolated TV surgery TV replacement: 57% | In-hospital mortality for isolated TV surgery: 9% | Cause of tricuspid disease is not reported, unclear if stenosis, regurgitation, primary or secondary. No long-term outcome data | |
| Pfannmüller et al, 201242 | Single-centre, retrospective cohort from 2000 to 2011 | 48 patients with severe TR following previous left cardiac surgery treated with minimally invasive TV surgery Mean age: 63.8 years Secondary TR: 90% TV repair: 69% Bioprosthetic valve: 25% Mechanical: 6% | 30-day mortality: 4.2% Early failure of TV repair: 12.5% Ring dehiscence: 9% (limited to semiflexible ring) 5-year survival 72% among those treated with elective surgery | No comparison to medical therapy | |
| Lee et al, 201041 | Single-centre, retrospective cohort study from 1996 to 2005 | 57 patients with TV surgery Mean age: 55 years Secondary TR: 69% TV repair: 75.4% Of the 57 patients, 45 were propensity matched according to surgery or medical therapy. | Overall hospital mortality for isolated TV surgery: 8.8% 10-year survival tended to be higher in the surgical patients after propensity matching (HR 0.29, P=0.068). | This is the only study to directly compare outcomes of medical and surgical management. High prevalence of primary TR in surgical patients | |
| Kim et al, 201339 | Single-centre, retrospective cohort study from 1996 to 2010 | 51 patients with TV surgery Mean age: 55.8 years Secondary TR: 35% TV repair: 72.5% Bioprosthetic valve: 19.6% Mechanical valve: 7.8% | In-hospital mortality: 2.0% 5-year survival: 83.5% 5-year survival free of CHF, transplant or reoperation: 77.3% Event-free survival predicted by RV end-systolic dimension, preoperative haemoglobin, GFR and bilirubin | No comparison to medical therapy End-systolic dimension reported continuously, it is unclear if there is a threshold effect. | |
| Staab et al, 199944 | Single-centre, retrospective cohort study of patients with TR following previous left heart valve surgery treated from 1980 to 1997 | 34 patients with symptomatic TR and history of prior left-sided valve surgery Mean age: 62.8 years At least moderate organic TV disease seen at surgery: 41.2% TV repair: 21% Bioprosthetic valve: 38% Mechanical valve: 41% | In-hospital mortality: 8.8% Mean 5-year survival: 49% Among survivors, 85% experienced symptomatic improvement. | Unclear how many events occurred in patients with primary versus secondary TR No comparison to medical therapy |
AV, aortic valve; AVR, aortic valve replacement; CABG, coronary artery bypass grafting; CHF, congestive heart failure; GFR, glomerular filtration rate; MV, mitral valve; NYHA, New York Heart Association; RV, right ventricle; TR, tricuspid regurgitation; TV, tricuspid valve.