Surgery Does Not Improve Survival in Patients With Isolated Severe Tricuspid Regurgitation

BACKGROUND Patients with isolated tricuspid regurgitation (TR) in the absence of left-sided valvular dysfunction are historically managed nonoperatively. OBJECTIVES To assess the impact of surgery for isolated TR, we compared survival for isolated severe TR patients who underwent surgery to those who did not. METHODS A longitudinal echocardiography database was used to perform a retrospective analysis on 3,276 adult patients with isolated severe TR from November 2001-March 2016. All-cause mortality for patients who underwent surgery versus those who did not was analyzed in the entire cohort and a propensity-matched sample. To assess the possibility of immortal time bias, the analysis was performed considering time from diagnosis to surgery as a time-dependent covariate. RESULTS Of 3,276 patients with isolated severe TR, 171 (5%) underwent tricuspid valve surgery, including 143 (84%) repairs and 28 (16%) replacements. The remaining 3,105 (95%) patients were medically managed. When considering surgery as a time-dependent covariate in a propensity matched sample, there was no difference in overall survival between patients who received medical versus surgical therapy (HR 1.34 0.78-2.30, p=0.288). In the subgroup that underwent surgery, there was no difference in survival between tricuspid repair versus replacement (HR 1.53 0.74-3.17, p=0.254). CONCLUSION In patients with isolated severe TR, surgery is not associated with improved long-term survival compared to medical management alone after accounting for immortal time bias.