JTCVS open · 2026
Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation.
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Sakurai Hironobu, Kainuma Satoshi, Kawamoto Naonori, Yamashita Kizuku, Suzuki Kota, Kakuta Takashi, Ikuta Ayumi, Kutsuzawa Rieko, Tadokoro Yuki, Miyatani Kazuki, Kurashima Shinichi, Irie Yuki, Moriuchi Kenji, Amano Masashi, Okada Atsushi, Amaki Makoto, Kanzaki Hideaki, Kitai Takeshi, Izumi Chisato, Yamamoto Kazuhiro, Fukushima Satsuki
Аннотация
OBJECTIVE: Massive or torrential tricuspid regurgitation is associated with poor survival; however, its impact on surgical results remains uncertain. Outcomes following tricuspid valve surgery in patients with severe versus massive or torrential tricuspid regurgitation were compared.
METHODS: From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years.
RESULTS: Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, P = .004). In-hospital mortality rates were 0% and 2.1%, respectively (P = .506). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation mild or less (73.9% vs 72.3%, P = .930). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs 81%, P = .358). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, P = .027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, P = .016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not.
CONCLUSIONS: Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.
METHODS: From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years.
RESULTS: Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, P = .004). In-hospital mortality rates were 0% and 2.1%, respectively (P = .506). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation mild or less (73.9% vs 72.3%, P = .930). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs 81%, P = .358). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, P = .027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, P = .016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not.
CONCLUSIONS: Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.