Impacts of Tricuspid Regurgitation and Concomitant Tricuspid Surgery in Aortic Valve Replacement

Background

Recent studies on the effects of preoperative tricuspid regurgitation (TR) severity and concomitant tricuspid valve (TV) surgery in patients undergoing aortic valve replacement (AVR) have yielded conflicting results, complicating the decision making on concomitant TV surgery in AVR.

Objectives

The purpose of this study was to investigate the impact of preoperative TR severity on outcomes of AVR and to assess the impact of concomitant TV surgery.

Methods

Patients who underwent AVR from 2000 to 2022 were included. The primary outcome was all-cause mortality, and the secondary outcome was a composite of mortality, TV-related reoperation, stroke, and heart failure. For patients with moderate TR, the impact of TV surgery was analyzed using the inverse probability of treatment weighting to address for selection bias.

Results

A total of 2,679 consecutive patients (median 7.22 years, Q1-Q3: 4.21-11.83 years) constituted the study cohort. At baseline, TR severity was none-to-trivial, mild, moderate, and severe in 1,688 (63.0%), 731 (27.3%), 215 (8.0%), and 45 (1.7%) patients, respectively. Clinical outcomes demonstrated significant disparities depending on baseline TR severity (P for trend < 0.001). After adjusting for potential covariates, TV surgery did not affect overall survival among patients with moderate TR (HR: 0.57; 95% CI: 0.21-1.50). However, the TV surgery group exhibited a favorable composite outcome and lower TV-related reoperation rate (HR: 0.37; 95% CI: 0.15-0.92, and subdistribution HR: 0.07; 95% CI: 0.01-0.63, respectively).

Conclusions

In patients who underwent AVR, baseline TR severity correlated with unfavorable clinical outcomes. Concomitant TV surgery reduced the rate of TV-related reoperations, but not mortality, among patients with moderate TR.