Although tricuspid regurgitation (TR) is a common finding, primary disease of the tricuspid valve (TV) is an uncommon lesion in developed countries.
1The more common “functional” TR, is a consequence of annular dilatation and distortion of the subvalvular apparatus, often resulting from right ventricular (RV) dilation and dysfunction.
- Cohen SR
- Sell JE
- McIntosh CL
- Clark RE
Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. I. Prevalence, diagnosis, and comparison of preoperative clinical and hemodynamic features in patients with and without tricuspid regurgitation.
J Thorac Cardiovasc Surg. 1987; 94: 481-487
2These features are most often driven by left heart disease, pulmonary hypertension, and atrial fibrillation. The unproven assumption that TR would improve or resolve when the left-sided lesion has been treated lead to a very conservative approach to anything less than severe TR.
- Mascherbauer J
- Maurer G
The forgotten valve: lessons to be learned in tricuspid regurgitation.
Eur Heart J. 2010; 31: 2841-2843
3Furthermore, the excessive morbidity and mortality associated with TV surgeries supported this approach, although untreated significant TR itself carries a poor long-term prognosis.
- Braunwald NS
- Ross J
- Morrow AG
Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement.
Circulation. 1967; 35: I63-I69
- Kilic A
- Saha-Chaudhuri P
- Rankin JS
- Conte J V
Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database.
Ann Thorac Surg. 2013; 96: 1546-1552
5Evidence generated over the past 15 years has led to a more aggressive approach to tricuspid repair in patients undergoing left heart valvular surgery.
- Nath J
- Foster E
- Heidenreich PA
Impact of tricuspid regurgitation on long-term survival.
J Am Coll Cardiol. 2004; 43: 405-409
- Dreyfus GD
- Corbi PJ
- Chan KM
- Bahrami T
Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?.
Ann Thorac Surg. 2005; 79: 127-132
- Chan V
- Burwash IG
- Lam B
- et al.
Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement.
Ann Thorac Surg. 2009; 88: 1209-1215
8In many instances of mitral regurgitation, particularly secondary to ischemic or nonischemic cardiomyopathy, the base disease might impair left and RV function progressing to significant tricuspid annular dilatation and leaflet tethering. Worsening of TR might continue despite correction of the mitral disease. Because this patient population is heterogeneous, disease progression is variable, being dependent on the baseline lesion, where early correction of degenerative mitral regurgitation shows the least TR progression.
- Lee J
- Song J
- Park JP
- et al.
Long-term prognosis of isolated significant tricuspid regurgitation.
Circ J. 2010; 74: 375-380
- Pozzoli A
- Lapenna E
- Vicentini L
- Alfieri O
- De Bonis M
Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.
Gen Thorac Cardiovasc Surg. 2016; 64: 509-516
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- Tricuspid regurgitation in patients with acquired, chronic, pure mitral regurgitation. I. Prevalence, diagnosis, and comparison of preoperative clinical and hemodynamic features in patients with and without tricuspid regurgitation.J Thorac Cardiovasc Surg. 1987; 94: 481-487
- The forgotten valve: lessons to be learned in tricuspid regurgitation.Eur Heart J. 2010; 31: 2841-2843
- Conservative management of tricuspid regurgitation in patients undergoing mitral valve replacement.Circulation. 1967; 35: I63-I69
- Trends and outcomes of tricuspid valve surgery in North America: an analysis of more than 50,000 patients from the Society of Thoracic Surgeons database.Ann Thorac Surg. 2013; 96: 1546-1552
- Impact of tricuspid regurgitation on long-term survival.J Am Coll Cardiol. 2004; 43: 405-409
- Secondary tricuspid regurgitation or dilatation: which should be the criteria for surgical repair?.Ann Thorac Surg. 2005; 79: 127-132
- Clinical and echocardiographic impact of functional tricuspid regurgitation repair at the time of mitral valve replacement.Ann Thorac Surg. 2009; 88: 1209-1215
- Long-term prognosis of isolated significant tricuspid regurgitation.Circ J. 2010; 74: 375-380
- Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.Gen Thorac Cardiovasc Surg. 2016; 64: 509-516
- Outcomes after surgery for functional tricuspid regurgitation: a systematic review and metaanalysis.Eur Heart J Qual Care Clin Outcomes. 2020; 6: 10-18
- Ring or suture annuloplasty for tricuspid regurgitation? A meta-analysis review.Ann Thorac Surg. 2014; 98: 2255-2263
- Flexible band versus rigid ring annuloplasty for tricuspid regurgitation: a systematic review and meta-analysis.Ann Cardiothorac Surg. 2017; 6: 194-203
- Development of a risk prediction model and clinical risk score for isolated tricuspid valve surgery.Ann Thorac Surg. 2018; 106: 129-136
- Long-term outcomes of tricuspid valve replacement after previous left-side heart surgery.Eur J Cardiothorac Surg. 2014; 46 ([discussion: 719]): 713-719
- Tricuspid leaflet augmentation to address severe tethering in functional tricuspid regurgitation.Eur J Cardiothorac Surg. 2008; 34: 908-910
- The clover technique for the treatment of complex tricuspid valve insufficiency: midterm clinical and echocardiographic results in 66 patients.Eur J Cardiothorac Surg. 2010; 37: 1297-1303
- Tricuspid valve repair: durability and risk factors for failure.J Thorac Cardiovasc Surg. 2004; 127: 674-685
- Surgery for tricuspid regurgitation late after mitral valve replacement.Circulation. 1984; 70: I193-I197
- First-in-human transcatheter tricuspid valve repair in a patient with severely regurgitant tricuspid valve.J Am Coll Cardiol. 2015; 65: 1190-1195
- Transcatheter tricuspid valve interventions: landscape, challenges, and future directions.J Am Coll Cardiol. 2018; 71: 2935-2956
- Transcatheter interventions for tricuspid valve disease: what to do and who to do it on.Can J Cardiol. 2021; 37: 953-967
- The International Multicenter TriValve Registry: which patients are undergoing transcatheter tricuspid repair?.JACC Cardiovasc Interv. 2017; 10: 1982-1990
- 1-Year outcomes after edge-to-edge valve repair for symptomatic tricuspid regurgitation: results from the TriValve Registry.JACC Cardiovasc Interv. 2019; 12: 1451-1461
- Transcatheter tricuspid valve intervention in patients with previous left valve surgery.Can J Cardiol. 2021; 37: 1094-1103
Published online: May 06, 2021
See article by Muntané-Carol et al., pages 1094-1102 of this issue.
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© 2021 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Transcatheter Tricuspid Valve Intervention in Patients With Previous Left Valve SurgeryCanadian Journal of CardiologyVol. 37Issue 7