Tricuspid Valve Replacement vs. Repair in Severe Tricuspid Regurgitation

Background: The aim of this study was to compare early and late outcomes of tricuspid valve replacement (TVR) and tricuspid valve repair (TVr) for severe tricuspid regurgitation (TR). Methods and Results: From 1994 to 2012, 360 patients (mean age, 58 +/- 13 years) with severe TR underwent TVR (n= 97, 27%) or TVr (n= 263, 73%). Among them, 282 patients (78%) had initial rheumatic etiology, and 307 patients (85%) had preoperative atrial fibrillation. The TVR group had higher total bilirubin, higher baseline central venous pressure, and higher incidence of previous cardiac operation. There was no difference in early mortality (TVR: TVr, 3.1%: 3.4%, P= 0.877). Ten-year overall survival (TVR: TVr, 72%: 70%, P= 0.532) and 10-year freedom from cardiac death (TVR: TVr, 76%: 77%, P= 0.715) were not significantly different between groups. After applying stabilized inverse probability of treatment weighting methods, there were still no significant differences in early mortality (P= 0.293), overall survival (P= 0.649) or freedom from cardiac death (P= 0.870). Higher NYHA functional class, total bilirubin (> 2 mg/dL), initial central venous pressure, and cardiopulmonary bypass time were independent predictors of early mortality. Older age, LV dysfunction (EF < 40%), and hemoglobin < 10 g/dL were independent predictors of late cardiac mortality. Conclusions: Compared with TVr, TVR had acceptable early and late outcomes in patients with severe TR. TVR can be considered as a valid option with acceptable clinical outcomes in patients who are not suitable candidates for TVr.