Abstract
Moderate-to-severe tricuspid regurgitation is associated with higher mortality and morbidity yet remains significantly undertreated. The reasons for this are complex but include a higher operative mortality for patients undergoing isolated tricuspid valve surgery. This study sought to determine the prevalence of patients with moderate-tosevere tricuspid regurgitation and identify those who could be potentially suitable for percutaneous tricuspid valve intervention by screening patients referred for transthoracic echocardiography (ECHO) at a tertiary center. Our results showed that the prevalence of moderate-to-severe tricuspid regurgitation in our total ECHO patient population was 2.8%. Of these, approximately one in eight patients with moderate-to-severe tricuspid regurgitation would be potentially suitable for percutaneous intervention and suggests a large, unmet clinical need in this population.
Highlights
It is estimated that tricuspid regurgitation occurs in 8–35% of patients [1] with several studies demonstrating that severe tricuspid regurgitation is associated with higher morbidity and mortality, independent of age or biventricular systolic function [2, 3].Despite this, current American Heart Association (AHA) and American College of Cardiology (ACC) guideline recommendations give a class I indication for tricuspid valve (TV) repair only for patients undergoing concomitant left-sided valve surgery [4]
One of the major reasons for the limited recommendation is the elevated surgical mortality rate associated with isolated TV surgery, which may be as high as 9.8% [6, 7]
12 000 patients were referred for Transthoracic Echo between January 1, 2016, and December 31, 2016, at King’s College Hospital, London
Summary
It is estimated that tricuspid regurgitation occurs in 8–35% of patients [1] with several studies demonstrating that severe tricuspid regurgitation is associated with higher morbidity and mortality, independent of age or biventricular systolic function [2, 3].Despite this, current American Heart Association (AHA) and American College of Cardiology (ACC) guideline recommendations give a class I indication for tricuspid valve (TV) repair only for patients undergoing concomitant left-sided valve surgery [4]. Percutaneous interventions targeting tricuspid regurgitation have recently begun to emerge These can broadly be categorized into several categories, namely edge-to-edge coaptation devices, annuloplasty devices, space occupying devices and caval valve implantation devices [8, 9]. These have been shown to be safe, to reduce tricuspid regurgitation (TR) and to improve quality of life outcomes. These have been limited to trials involving a relatively small number of patients [10, 11].
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