Invasive management of significant tricuspid regurgitation in clinical practice

• Published in: International journal of cardiology Vol. 375; pp. 66 - 73
• Main Authors: Moral, Sergio, Abulí, Marc, Méndez, Irene, González-Gómez, Ariana, García-Quintana, Antonio, Menduiña, Irene, Payá, Rafael, Esteban, Esther, Sánchez, Pedro Luis, Díaz, Elena, de la Morena, Gonzalo, Calvo-Iglesias, Franciso, Gallego, Pastora, Ballesteros, Esther, Brugada, Ramon, Evangelista, Arturo
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15-03-2023
• Subjects: Cardiology; Heart Valve Diseases - surgery; Heart Valve Prosthesis Implantation; Humans; Prognosis; Surgery; Surveys and Questionnaires; Treatment Outcome; Tricuspid regurgitation; Tricuspid Valve Insufficiency - diagnosis; Tricuspid Valve Insufficiency - surgery; Valve heart disease; NYHA; TV; VHD; RV; Surgery; LVEF; Valve heart disease; Tricuspid regurgitation; HF; TR
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2023.01.005

Tricuspid regurgitation (TR) is a prevalent condition inside valvular heart disease (VHD) with relevant prognosis implications. However, concordance between real management in clinical practice and invasive treatment recommendations of European Society of Cardiology (ESC) guidelines is unknown.
A substudy of ESC VHD II survey was performed to evaluate the real treatment of TR compared to the clinical ESC guidelines recommendations published in 2012, 2017 and 2021 was performed. TR cases with surgical indication were divided in 3 groups: 1: severe isolated TR without previous left VHD; 2: moderate/severe TR and concomitant severe left VHD; 3: severe TR plus previous left VHD surgery.
Of 902 patients assessed, 123 had significant TR. Fifty (41%) cases demonstrated ESC guidelines 2012–2017 Class I or IIa recommendations for invasive treatment: 9(18%) of group 1, 37(74%) of group 2 and 4(8%) of group 3. Surgery was performed in 24 patients (48%); 1 in group 1(4%), 22 in group 2(92%) and 1 in group 3(4%). Overall concordance was 48% (group 1: 11%; group 2: 59%; group 3: 25%). Regarding the 2021 ESC guidelines only one patient changed groups with an overall concordance of 47% (group 1: 10%; group 2: 59%; group 3: 25%).
Concordance between 2012, 2017 and 2021 ESC guidelines recommendations and clinical practice for TR surgical intervention is low, especially in those without concomitant severe left VHD. These results suggest the need to improve further guideline implementation and alternative treatments, such as percutaneous, which could resolve potential discrepancies in those clinical scenarios.
•Tricuspid regurgitation is a prevalent condition inside valvular heart disease with relevant prognosis implications.•Surgical indication for asymptomatic patients with TR without involvement of left-sided VHD remains controversial.•Concordance between significant TR invasive management in clinical practice and ESC guidelines recommendations is low.•Patients undergoing surgery show differences in baseline characteristics compared to those with indicated but not performed.