Abstract 11678: Tricuspid Valve Repair Versus Replacement for Very Severe Functional Tricuspid Regurgitation

Introduction: The optimal decision regarding whether to repair or replace the tricuspid valve (TV) remains controversial in patients with very severe functional tricuspid regurgitation (TR). Objectives: We sought to compare clinical outcomes of TV repair versus replacement for very severe TR associated with severe TV tethering. Methods: We included 96 consecutive patients (20 men, 58±11 years of age) who had both severe tethering of TV and very severe functional TR, and consequently underwent TV surgery during left-sided valve surgery. TV repair was performed on 79 patients (repair group), whereas 17 patients underwent TV replacement (replacement group). The primary end-point of the study was defined as the composite of operative mortality, cardiac death, repeat TV surgery and hospitalization due to congestive heart failure during follow-up. Results: The two groups had similar baseline clinical, echocardiographic and operative characteristics, but operative mortality was significantly higher in the replacement group than in the repair group (P=0.008). During a median follow-up of 87 months, 19 (24%) patients in the repair group and 8 (47%) in the replacement group attained the composite end point, and the estimated 10-year event-free survival rate was significantly higher in the repair group (75 ± 6%) than in the replacement group (43 ± 2%) (P = 0.019). TV replacement was independently associated with end points in the Cox proportional hazards analysis after adjustment with propensity score (hazard ratio, 4.033; 95% CI, 1.470 to 11.071; P=0.007). Conclusions: Compared with TV repair, replacement was associated with higher operative mortality and worse long-term clinical outcomes in patients with very severe functional TR. Repair should be the preferred surgical option even for severe TR associated with more advanced tethering and right ventricular dilatation.