Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE.

IF 37.6 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS European Heart Journal Pub Date : 2024-11-08 DOI:10.1093/eurheartj/ehae578

Julien Dreyfus, Fernando Juarez-Casso, Alessandra Sala, Manuel Carnero-Alcazar, Andrea Eixerés-Esteve, Yohann Bohbot, Baptiste Bazire, Michele Flagiello, Elisabeth Riant, Yannick Mbaki, Jacques Tomasi, Thomas Senage, Kenza Rahmouni El Idrissi, Augustin Coisne, Damien Eyharts, Fabien Doguet, Florence Viau, Florian Eggenspieler, Samuel Heuts, Peyman Sardari Nia, Gregor Heitzinger, Xavier Galloo, Nina Ajmone Marsan, Giovanni Benfari, Luigi Badano, Denisa Muraru, Francesco Maisano, Yan Topilsky, Hector Michelena, Maurice Enriquez-Sarano, Jeroen Bax, Philipp Bartko, Christine Selton-Suty, Gilbert Habib, Yoan Lavie-Badie, Thomas Modine, Vincent Chan, Thierry Le Tourneau, Erwan Donal, Pascal Lim, Costin Radu, Jordan Bernick, George A Wells, Christophe Tribouilloy, Bernard Iung, Jean-François Obadia, Michele De Bonis, Juan Crestanello, David Messika-Zeitoun

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Abstract

Background and aims: Severe tricuspid regurgitation is associated with increased mortality rates, but benefit of its correction and ideal timing are not clearly determined. This study aimed to identify patient subsets who might benefit from the surgery.

Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional tricuspid regurgitation (33 centres, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, and high: ≥6).

Results: One thousand and two hundred seventeen were managed conservatively, and 551 underwent isolated tricuspid valve surgery (200 repairs and 351 replacements). TRI-SCORE distribution was 33% low, 32% intermediate, and 35% high. At 10 years, survival rates were similar between surgical and conservative management [41% vs. 36%; hazard ratio (HR) .97; 95% confidence interval (CI) .88-1.08, P = .57]. Surgery improved survival compared with conservative management in the low TRI-SCORE category (72% vs. 44%; HR .27; 95% CI .20-.37, P < .0001), but not in the intermediate (36% vs. 37%; HR 1.17; 95%CI .98-1.40, P = .09) or high categories (20% vs. 24%; HR 1.06; 95% CI .91-1.25, P = .45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR .11; 95% CI .06-.19, P < .0001, and HR .65; 95% CI .47-.90, P = .009). Repair showed benefit in the intermediate category (59% vs. 37%; HR .49; 95% CI .35-.68, P < .0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P = .0002).

Conclusions: Higher survival rates were observed with repair than replacement and benefit of intervention declined as TRI-SCORE increased with no benefit of any type of surgery in the high TRI-SCORE category. These results emphasize the importance of timely intervention and patient selection to achieve the best outcomes and the need for randomized controlled trials.

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功能性三尖瓣反流的孤立手术瓣膜修复或置换术的益处以及根据 TRI-SCORE 分层的长期疗效。

背景和目的：严重三尖瓣反流（TR）与死亡率升高有关，但其矫正的益处和理想时机尚未明确确定。本研究旨在确定可能从手术中获益的患者亚群：方法：TRIGISTRY是一项针对严重孤立功能性TR连续患者的国际队列研究（10个国家，33个中心），该研究比较了接受孤立三尖瓣（TV）手术（修复或置换）和保守治疗的患者长达10年的存活率，并根据TRI-SCORE类别（低：≤3，中：4-5，高：≥6）进行比较：1,217人接受了保守治疗，551人接受了单独的TV手术（200人进行了修复，351人进行了置换）。TRI-SCORE分布为低33%，中32%，高35%。10年后，手术和保守治疗的存活率相似（41% 对 36%；危险比 [HR] 0.97；95% 置信区间 [CI] 0.88-1.08，P=0.57）。与保守治疗相比，手术提高了低 TRI-SCORE 类别患者的生存率（72% 对 44%；HR 0.27；95% CI 0.20-0.37, PConclusions：在高 TRI-SCORE 组别中，任何类型的手术都没有益处。这些结果强调了及时干预和选择患者以获得最佳疗效的重要性，以及进行随机对照试验的必要性：TRIGISTRY：试验注册：TRIGISTRY：ClinicalTrials.gov，NCT05825898。

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来源期刊

European Heart Journal 医学-心血管系统

CiteScore

39.30

自引率

6.90%

发文量

3942

审稿时长

1 months

期刊介绍： The European Heart Journal is a renowned international journal that focuses on cardiovascular medicine. It is published weekly and is the official journal of the European Society of Cardiology. This peer-reviewed journal is committed to publishing high-quality clinical and scientific material pertaining to all aspects of cardiovascular medicine. It covers a diverse range of topics including research findings, technical evaluations, and reviews. Moreover, the journal serves as a platform for the exchange of information and discussions on various aspects of cardiovascular medicine, including educational matters. In addition to original papers on cardiovascular medicine and surgery, the European Heart Journal also presents reviews, clinical perspectives, ESC Guidelines, and editorial articles that highlight recent advancements in cardiology. Additionally, the journal actively encourages readers to share their thoughts and opinions through correspondence.