Long-Term Prognosis of Isolated Significant Tricuspid Regurgitation

• Published in: Circulation Journal Vol. 74; no. 2; pp. 375 - 380
• Main Authors: Lee, Jeong-Woo, Song, Jong-Min, Park, Jong Pil, Lee, Jae Won, Kang, Duk-Hyun, Song, Jae-Kwan
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 2010
• Subjects: Aged; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - mortality; Cardiovascular Agents - therapeutic use; Female; Humans; Hypertension, Pulmonary - etiology; Hypertension, Pulmonary - mortality; Hypertension, Pulmonary - therapy; Kaplan-Meier Estimate; Male; Middle Aged; Prognosis; Propensity Score; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Severity of Illness Index; Surgery; Time Factors; Treatment Outcome; Tricuspid valve; Tricuspid Valve Insufficiency - complications; Tricuspid Valve Insufficiency - mortality; Tricuspid Valve Insufficiency - surgery; Ventricular Dysfunction, Right - etiology; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - therapy
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.CJ-09-0679

Background: The prognostic implications and surgical benefit of isolated significant tricuspid regurgitation (TR) and prognostic factors in patients with TR were investigated. Methods and Results: In 870 consecutive patients with significant isolated TR, all-cause mortality was analyzed over 4.9±2.9 years. It was found that the survival rate tended to be higher in the 57 patients who underwent tricuspid valve (TV) surgery than the 813 patients who did not by using propensity-score matching (P=0.068), although it was not significant. Of the 813 patients that did not undergo TV surgery, the 5-year survival rate was 74%. According to the Cox proportional hazards model, the initial TR jet area (hazard ratio [HR], 1.044; 95% confidence interval [CI], 1.016-1.073), pulmonary artery systolic pressure (HR, 1.024; 95%CI, 1.017-1.032) and presence of right ventricular (RV) dysfunction (HR, 2.256; 95% CI, 1.329-3.828) were predictors of mortality independent of patient age and presence of diabetes mellitus and renal failure in medically managed patients. Conclusions: In patients with isolated significant TR, there was a tendency, although not significant, towards a higher survival rate after TV surgery. The severity of TR and pulmonary hypertension, and the presence of RV dysfunction are independent prognostic factors in medically managed patients. Further prospective randomized studies are necessary to demonstrate the benefit of TV surgery in these poor prognostic populations. (Circ J 2010; 74: 375-380)