Is very Tight Really Right? Survival after Minimally Invasive Tricuspid Surgery According to Grade of Regurgitation at Discharge

Background: Patients with isolated tricuspid valve disease are a challenging population to treat for cardiac surgeons. Survival is still impaired, even after minimally invasive surgery. The role of residual tricuspid regurgitation (TR) is often debated in the context of long-term survival.

Methods: From 2019 to 2024, 53 patients underwent minimally invasive, isolated tricuspid valve surgery at our center. We compared outcomes according to degree of TR at discharge. TR grading system was 1 to 5, according to internationally established definitions.

Results: Mean age was 65.2 ± 15.5 years, 45.3% (24/53) patients were female and mean TRI-SCORE was 4.6 ± 1.8 points. EuroSCORE II was 5.4% ± 4.8%. Valves were replaced in 30.2% (16/53). 7.5% (4/53) of patients had previous edge-to-edge repair procedure; the procedure was a re-operative procedure in 24.5% (13/53). The procedure was beating heart in 77.3% (41/53). 30-day overall mortality was 5.7% (3/53) and 1-year mortality was 9.4% (5/53). 24.5% (13/53) of patients had more than mild TR at discharge. Patients with more than mild TR at discharge were older (71.9 ± 9.6 versus 63.0 ± 16.5 years, p < 0.01), had a higher TRI-SCORE (5.7 ± 1.9 versus 4.2 ± 1.6 points, p < 0.01), and a higher EuroSCORE II (8.6 ± 4.4% versus 4.7 ± 4.6%, p < 0.01). Right ventricular function according to TAPSE and tricuspid annulus diameter were not different between patients (p = 0.92 and p = 0.19). TR was numerically more often secondary at baseline in patients with residual TR (76.9% [10/13] versus 65.8% [27/41], p = 0.45) and more often torrential (grade 5) at baseline in patients with >mild TR at discharge (53.8% [7/13] versus 40.0% [16/40], p = 0.52). One-year survival in patients with more than mild TR was significantly lower (51.9% versus 100% survival, p < 0.01); the difference remained significant after adjusting survival for TRI-SCORE and age using COX regression.

Conclusion: Survival of patients with residual TR is significantly lower after surgery; however, there remains a hen’s egg problem of those patients being at higher risk for surgery to begin with. The ramifications of leaving some TR behind in patients with secondary TR at higher risk for right heart failure are not well understood and need further investigation.

Publication History

Article published online:
11 February 2025