Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation

Massive or torrential tricuspid regurgitation is associated with poor survival; however, its impact on surgical results remains uncertain. Outcomes following tricuspid valve surgery in patients with severe versus massive or torrential tricuspid regurgitation were compared.

From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years.

Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, P = .004). In-hospital mortality rates were 0% and 2.1%, respectively (P = .506). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation mild or less (73.9% vs 72.3%, P = .930). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs 81%, P = .358). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, P = .027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, P = .016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not.

Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.