TY - JOUR
T1 - Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE
AU - Dreyfus, Julien
AU - Juarez-Casso, Fernando
AU - Sala, Alessandra
AU - Carnero-Alcazar, Manuel
AU - Eixerés-Esteve, Andrea
AU - Bohbot, Yohann
AU - Bazire, Baptiste
AU - Flagiello, Michele
AU - Riant, Elisabeth
AU - Mbaki, Yannick
AU - Tomasi, Jacques
AU - Senage, Thomas
AU - Rahmouni El Idrissi, Kenza
AU - Coisne, Augustin
AU - Eyharts, Damien
AU - Doguet, Fabien
AU - Viau, Florence
AU - Eggenspieler, Florian
AU - Heuts, Samuel
AU - Sardari Nia, Peyman
AU - Heitzinger, Gregor
AU - Galloo, Xavier
AU - Ajmone Marsan, Nina
AU - Benfari, Giovanni
AU - Badano, Luigi
AU - Muraru, Denisa
AU - Maisano, Francesco
AU - Topilsky, Yan
AU - Michelena, Hector
AU - Enriquez-Sarano, Maurice
AU - Bax, Jeroen
AU - Bartko, Philipp
AU - Selton-Suty, Christine
AU - Habib, Gilbert
AU - Lavie-Badie, Yoan
AU - Modine, Thomas
AU - Chan, Vincent
AU - Le Tourneau, Thierry
AU - Donal, Erwan
AU - Lim, Pascal
AU - Radu, Costin
AU - Bernick, Jordan
AU - Wells, George A
AU - Tribouilloy, Christophe
AU - Iung, Bernard
AU - Obadia, Jean-François
AU - De Bonis, Michele
AU - Crestanello, Juan
AU - Messika-Zeitoun, David
AU - TRIGISTRY investigators
PY - 2024/11/7
Y1 - 2024/11/7
N2 - Background and Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are Aims not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery. Methods In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4–5, and high: ≥6). Results One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88–1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20–.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98–1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91–1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06–.19, P < .0001, and HR .65; 95% CI .47–.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35–.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18–1.72, P = .0002). Conclusions Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.
AB - Background and Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are Aims not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery. Methods In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4–5, and high: ≥6). Results One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88–1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20–.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98–1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91–1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06–.19, P < .0001, and HR .65; 95% CI .47–.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35–.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18–1.72, P = .0002). Conclusions Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.
KW - management
KW - outcome
KW - surgery
KW - tricuspid regurgitation
U2 - 10.1093/eurheartj/ehae578
DO - 10.1093/eurheartj/ehae578
M3 - Article
SN - 0195-668X
VL - 45
SP - 4512
EP - 4522
JO - European Heart Journal
JF - European Heart Journal
IS - 42
ER -