Abstract 19004: Clinical Outcomes Following Treatment for Tricuspid Regurgitation: Repair vs. Replacement

Abstract

Background: Tricuspid regurgitation (TR). previously regarded as the ‘forgotten valvular disease’, has gained a lot interest lately due to its deleterious effects on the right ventricle and long-term outcomes. Surgical literature on outcomes after isolated tricuspid surgery is limited. Although, the guidelines recommend repair of the tricuspid valve, few studies compare outcomes of replacement with repair. Research Question and Aims: Whether, tricuspid repair or replacement is the optimal therapy for TR is not fully understood. Therefore, we sought to compare outcomes and survival after the two techniques. Methods: Our institutional STS database was queried to identify patients who underwent surgery for TR from 2017-2022. Of the 200 patients identified, 84 were excluded due to major concomitant procedures. After exclusion, 70 patients underwent tricuspid replacement and 46 underwent repair. Pre-, intra- and post-operative characteristics were tabulated and compared using t-tests and fisher’s exact test. 5-year survival was analyzed using Kaplan-Meier curves. Results: Tricuspid repair was notably done in a significantly older patient population compared to replacement (p=0.005) likely due to presence of more endocarditis in the younger population who underwent replacement (Figure 1). Tricuspid repair was associated with a significantly longer cross-clamp time. Post-operative complications including pacemaker implantation rates were not significantly different between the groups. 30-day and 5-year mortality rate was also not found to be significantly different between the two interventions. From the limited mid-term echo follow up, TAPSE reduced to 1.5 from 2.1 in the repair group (p=0.01). Conclusions: Younger patients with endocarditis underwent more replacements than repairs. 30-day outcomes and 5-year survival were not significantly different in the two groups however, RV function seemed to worsen in patients who underwent TV repair.