title: Comparison of Results of Tricuspid Valve Repair Versus Replacement for Severe Functional Tricuspid Regurgitation.
abstract: The optimal decision regarding whether to repair or replace the tricuspid valve (TV) remains controversial in patients with very severe functional tricuspid regurgitation (TR). We sought to compare clinical outcomes of TV repair versus replacement for very severe TR associated with severe TV tethering. We included 96 consecutive patients (20 men, 58 ± 11 years of age) who had both severe tethering of TV and very severe functional TR and consequently underwent TV surgery during left-sided valve surgery. TV repair was performed on 79 patients (repair group), whereas 17 patients underwent TV replacement (replacement group). The primary end point of the study was defined as the composite of operative mortality, cardiac death, repeat TV surgery, and hospitalization due to congestive heart failure during follow-up. The 2 groups had similar baseline clinical, echocardiographic, and operative characteristics, but operative mortality was significantly higher in the replacement group than in the repair group (p = 0.008). During a median follow-up of 87 months, 19 patients (24%) in the repair group and 8 (47%) in the replacement group attained the composite end point, and TV replacement was independently associated with end points in the Cox proportional hazards analysis after adjustment with propensity score (hazard ratio 4.033, 95% CI 1.470 to 11.071; p = 0.007). In conclusion, compared with TV repair, replacement was associated with higher operative mortality and worse long-term clinical outcomes in patients with very severe functional TR. Repair should be the preferred surgical option even for severe TR associated with more advanced tethering and right ventricular dilatation.
authors.affiliation: Division of Cardiology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea.
authors.forename: Jeong Yoon
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Ran
authors.initials: R
authors.lastname: Heo
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Sahmin
authors.initials: S
authors.lastname: Lee
authors.affiliation: Division of Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Division of Biostatistics, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Sung-Cheol
authors.initials: SC
authors.lastname: Yun
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Jong-Min
authors.initials: JM
authors.lastname: Song
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.affiliation: Division of Cardiac Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Jae-Won
authors.initials: JW
authors.lastname: Lee
authors.affiliation: Division of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. Electronic address: dhkang@amc.seoul.kr.
authors.forename: Duk-Hyun
authors.initials: DH
authors.lastname: Kang
mesh_terms: D018618:Echocardiography, Doppler, Color; D023381:Endpoint Determination; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012042:Registries; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*