Log in to MyACC
Surgery for Severe Tricuspid Regurgitation
Study Questions:
What is the impact of surgery for isolated tricuspid regurgitation (TR) in the absence of left-sided valvular dysfunction?
Methods:
The investigators used a longitudinal echocardiography database to perform a retrospective analysis on 3,276 adult patients with isolated severe TR from November 2001-March 2016. All-cause mortality for patients who underwent surgery versus those who did not was analyzed in the entire cohort and a propensity-matched sample. To assess the possibility of immortal time bias, the analysis was performed considering time from diagnosis to surgery as a time-dependent covariate. To address variables that confound the relationship between treatment decision and death, a Cox proportional hazards model was constructed to identify independent risk factors for mortality.
Results:
Of 3,276 patients with isolated severe TR, 171 (5%) underwent tricuspid valve surgery, including 143 (84%) repairs and 28 (16%) replacements. The remaining 3,105 (95%) patients were medically managed. When considering surgery as a time-dependent covariate in a propensity-matched sample, there was no difference in overall survival between patients who received medical versus surgical therapy (hazard ratio [HR], 1.34; 95% confidence interval [CI], 0.78-2.30; p = 0.288). In the subgroup that underwent surgery, there was no difference in survival between tricuspid repair versus replacement (HR, 1.53; 95% CI, 0.74-3.17; p = 0.254).
Conclusions:
The authors concluded that in patients with isolated severe TR, surgery is not associated with improved long-term survival compared to medical management alone.
Perspective:
This study reports no difference in long-term survival regardless of whether patients with isolated severe TR underwent surgery or medical therapy alone after accounting for immortal time bias. Furthermore, in the surgical group, tricuspid valve repair versus replacement was not associated with a survival difference. The current study emphasizes the importance of accounting for immortal time bias in assessing the efficacy of surgical procedures using longitudinal observational data, and future studies of novel percutaneous therapies for severe TR should focus on the optimal timing of intervention in patients with TR with respect to overall survival and quality of life.
Keywords: Cardiac Surgical Procedures, Echocardiography, Heart Valve Diseases, Quality of Life, Risk Factors, Secondary Prevention, Survival Analysis, Tricuspid Valve Insufficiency, Ventricular Dysfunction, Left
< Back to Listings
