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Practice Gap in Addressing Secondary Tricuspid Regurgitation During Systemic Valve Surgery for Rheumatic Heart

Siddharth V Som1, Ankus S Kotwal1, Amit Rastogi2

  • 1Cardiovascular Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, IND.

Cureus
|October 6, 2025
PubMed

Insights

This study found that tricuspid regurgitation (TR) progression was similar in patients with severe TR and pulmonary hypertension, whether or not they had tricuspid valve repair (TVr). Further investigation is needed for this patient group.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Practice Guidelines

Background:

  • Tricuspid regurgitation (TR) is a common complication in patients undergoing left-sided valve surgery.
  • Addressing TR in these patients presents a practice gap, particularly concerning the need for tricuspid valve repair (TVr).

Purpose of the Study:

  • To analyze the practice gap in managing tricuspid regurgitation (TR) in patients undergoing left-sided valve surgery.
  • To evaluate the outcomes of TVr in patients with moderate to severe TR and a dilated tricuspid valve annulus.

Main Methods:

  • Retrospective cohort study of 1,129 patients undergoing left-sided valve operations for rheumatic heart disease between 2015-2018.
  • Patients were divided into four groups based on TR severity and pulmonary arterial hypertension (PAH) status.
  • Primary endpoint was the appearance of severe TR at follow-up; TVr was performed in 68 patients with moderate to severe TR and a dilated annulus.

Main Results:

  • The primary endpoint (severe TR) was observed in 6.3% (mild TR), 21.1% (severe TR with PAH), 49.5% (severe TR, non-severe PAH), and 23.5% (moderate-severe TR with dilated annulus).
  • Severe TR developed more frequently in patients with moderate TR preoperatively (p=0.04).
  • There was a departure from AHA/ACC guidelines in 66.6% of cases involving severe TR; severe TR emergence was similar in Group 2 (no TVr) and Group 4 (TVr).

Conclusions:

  • The development of severe TR during follow-up was similar for patients with preoperative severe TR and severe pulmonary hypertension, regardless of TVr.
  • The need for TVr in patients with severe TR and severe pulmonary hypertension requires further investigation.
Abstract

Keywords:
long term followupoutcome analysisrheumatic valvular heart diseasesecondary tricuspid regurgitationvalve replacement surgery

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