Julien Dreyfus, Fernando Juarez-Casso, Alessandra Sala, Manuel Carnero-Alcazar, Andrea Eixerés-Esteve, Yohann Bohbot, Baptiste Bazire, Michele Flagiello, Elisabeth Riant, Yannick Mbaki, Jacques Tomasi, Thomas Senage, Kenza Rahmouni El Idrissi, Augustin Coisne, Damien Eyharts, Fabien Doguet, Florence Viau, Florian Eggenspieler, Samuel Heuts, Peyman Sardari Nia, Gregor Heitzinger, Xavier Galloo, Nina Ajmone Marsan, Giovanni Benfari, Luigi Badano, Denisa Muraru, Francesco Maisano, Yan Topilsky, Hector Michelena, Maurice Enriquez-Sarano, Jeroen Bax, Philipp Bartko, Christine Selton-Suty, Gilbert Habib, Yoan Lavie-Badie, Thomas Modine, Vincent Chan, Thierry Le Tourneau, Erwan Donal, Pascal Lim, Costin Radu, Jordan Bernick, George A Wells, Christophe Tribouilloy, Bernard Iung, Jean-François Obadia, Michele De Bonis, Juan Crestanello, David Messika-Zeitoun
{"title":"Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE.","authors":"Julien Dreyfus, Fernando Juarez-Casso, Alessandra Sala, Manuel Carnero-Alcazar, Andrea Eixerés-Esteve, Yohann Bohbot, Baptiste Bazire, Michele Flagiello, Elisabeth Riant, Yannick Mbaki, Jacques Tomasi, Thomas Senage, Kenza Rahmouni El Idrissi, Augustin Coisne, Damien Eyharts, Fabien Doguet, Florence Viau, Florian Eggenspieler, Samuel Heuts, Peyman Sardari Nia, Gregor Heitzinger, Xavier Galloo, Nina Ajmone Marsan, Giovanni Benfari, Luigi Badano, Denisa Muraru, Francesco Maisano, Yan Topilsky, Hector Michelena, Maurice Enriquez-Sarano, Jeroen Bax, Philipp Bartko, Christine Selton-Suty, Gilbert Habib, Yoan Lavie-Badie, Thomas Modine, Vincent Chan, Thierry Le Tourneau, Erwan Donal, Pascal Lim, Costin Radu, Jordan Bernick, George A Wells, Christophe Tribouilloy, Bernard Iung, Jean-François Obadia, Michele De Bonis, Juan Crestanello, David Messika-Zeitoun","doi":"10.1093/eurheartj/ehae578","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.</p><p><strong>Methods: </strong>In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).</p><p><strong>Results: </strong>One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88-1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20-.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98-1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91-1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06-.19, P < .0001, and HR .65; 95% CI .47-.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35-.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P = .0002).</p><p><strong>Conclusions: </strong>Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.</p>","PeriodicalId":11976,"journal":{"name":"European Heart Journal","volume":" ","pages":"4512-4522"},"PeriodicalIF":37.6000,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/eurheartj/ehae578","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background and aims: Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.
Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).
Results: One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88-1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20-.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98-1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91-1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06-.19, P < .0001, and HR .65; 95% CI .47-.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35-.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P = .0002).
Conclusions: Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.
期刊介绍：
The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters.
In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.
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