Work

Practice Gap in Addressing Secondary Tricuspid Regurgitation During Systemic Valve Surgery for Rheumatic Heart Disease: A Retrospective Cohort Study

Year: 2025

Type: article

Abstract: BACKGROUND & AIMS: This study analyses the practice gap in addressing tricuspid regurgitation (TR) in patients undergoing left-sided valve surgery. METHODS: This 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. RESULTS: The 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. CONCLUSION: The 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.

Source: Cureus

DOI: 10.7759/cureus.91440