ArticleCureus2025
Practice Gap in Addressing Secondary Tricuspid Regurgitation During Systemic Valve Surgery for Rheumatic Heart Disease: A Retrospective Cohort Study.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND &
aimsThis study analyses the practice gap in addressing tricuspid regurgitation (TR) in patients undergoing left-sided valve surgery.
methodsThis is a retrospective cohort study of patients operated on between January 2015 and December 2018. A total of 1,129 patients underwent left-sided valve operations for rheumatic aetiology. Tricuspid valve repair (TVr) was performed in 68 patients. Patients with follow-up data and isolated or predominantly mitral valve replacement were divided based on the severity of TR: Group 1 (n = 771), patients with mild TR; Group 2 (n = 109), patients with severe TR and severe pulmonary arterial hypertension (PAH); Group 3 (n = 33), patients with severe TR and non-severe PAH; and Group 4 (n = 68), patients with moderate to severe TR and a dilated tricuspid valve annulus. Group 4 patients received TVr. The primary endpoint was the appearance of severe TR at follow-up.
resultsThe mean age of the whole cohort of 1,129 patients (n = 598 (53%) males and n = 531 (47%) females) was 35.42 ± 13.91 years. Mean follow-up of 27.3 ± 18.9 months was available for 1,061 patients. The primary endpoint was observed in 6.3%, 21.1%, 49.5%, and 23.5% of patients, respectively, from Group 1 to Group 4. Preoperatively, mild TR was observed in 771, moderate in 147, and severe in 143 patients who completed follow-up. The primary endpoint was more common in patients with moderate TR (p = 0.04). The American Heart Association (AHA) and American College of Cardiology (ACC) collaborate to produce clinical practice guidelines providing evidence-based recommendations to improve cardiovascular health. These guidelines are the official policy of both organisations and are intended to provide a foundation for quality cardiovascular care globally, though the focus is on US medical practice. There was a departure from the recommendation in 66.6% of cases (Groups 2 and 3) involving patients with severe TR (Groups 2-4). The emergence of severe TR in Groups 2 and 4 was similar, even though patients in Group 2 did not receive TVr, contrary to the recommendation.
conclusionThe appearance of severe TR during follow-up for patients with preoperatively severe TR with severe pulmonary hypertension (PH) was similar, irrespective of whether TVr was performed. This group should be further investigated regarding the need for TVr.
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