Patients with isolated tricuspid regurgitation (i.e., who have no associated left-sided valve disease) are frequently treated conservatively. In many cases, valve disease is highly symptomatic, even with the optimization of medical treatment; however, an invasive strategy is seldom proposed.

The aim of this work was to measure the impact of surgery on isolated tricuspid regurgitation compared to medical treatment alone.

Researchers conducted a retrospective analysis of 3276 patients with pure tricuspid regurgitation who were included in an echocardiography database between November 2001 and March 2016. All-cause mortality for patients who underwent surgery versus those who received medical treatment alone was compared using propensity score matching to balance baseline differences.

Among 3276 patients with isolated tricuspid regurgitation, only 171 (5%) underwent surgery (143 for valve repair and 28 for valve replacement). The remaining 3105 patients were managed with medical treatment.

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Upon analysis, there were no differences between the patients who underwent surgery and those who did not (hazard ratio [HR]: 1.34; p = 0.288).

In the surgical subgroup, there were no differences between repair and replacement surgery patients (HR: 1.53; p = 0.254).

Conclusion

Patients with isolated tricuspid regurgitation do not benefit from surgery in terms of long-term survival compared to medical treatment alone.

Original Title: Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation.

Reference: Andrea L. Axtell et al. J Am Coll Cardiol 2019;74:715–25.

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