Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation

Q: What does this research mean for the field?

Tricuspid valve surgery yields comparable perioperative mortality and long-term survival in patients with massive or torrential tricuspid regurgitation compared to severe tricuspid regurgitation, with prognosis driven by baseline cardiac and renal function rather than baseline regurgitation severity. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Hironobu Sakurai; Satoshi Kainuma; Naonori Kawamoto; Kizuku Yamashita; Kota Suzuki; Takashi Kakuta; Ayumi Ikuta; Rieko Kutsuzawa; Yuki Tadokoro; K Miyatani; Shinichi Kurashima; Yuki Irie; Kenji Moriuchi; Masashi Amano; Atsushi Okada; Makoto Amaki; Hideaki Kanzaki; Takeshi Kitai; Chisato Izumi; Kazuhiro Yamamoto; Satsuki Fukushima

doi:10.1016/j.xjon.2026.101944

Figures

Graphical abstract published by JTCVS Open — Graphical abstract · Published by JTCVS Open · CC BY

Why the study?

Massive or torrential tricuspid regurgitation is associated with poor survival, but its impact on surgical results remains uncertain.

Does baseline massive or torrential tricuspid regurgitation worsen mortality, heart failure readmission, and postoperative regurgitation grade compared to severe tricuspid regurgitation in symptomatic patients undergoing tricuspid valve surgery?

Key Points

To compare clinical outcomes and survival following tricuspid valve surgery between patients with severe versus massive or torrential tricuspid regurgitation.
Retrospective analysis of 164 symptomatic patients (mean age 71.2 ± 10.4 years) undergoing isolated or concomitant tricuspid valve surgery between 2010 and 2024.
Patients were stratified into severe (n = 69, 42%) and massive or torrential (n = 95, 58%) tricuspid regurgitation cohorts.
Primary endpoint was postoperative tricuspid regurgitation grade; predictors of mortality and heart failure hospitalization were tracked over a mean follow-up of 4.6 ± 3.9 years.
Tricuspid repair was performed in 96% vs 80% (P=0.004) of severe vs massive/torrential cases, while in-hospital mortality was 0% vs 2.1% (P=0.51) and residual regurgitation ≤ mild occurred in 73.9% vs 72.3% (P=0.91).
Five-year survival was 85% in severe versus 81% in massive/torrential groups (P=0.36), with 26 total deaths and 38 heart failure hospitalizations observed during follow-up.
Adverse outcomes were independently predicted by baseline left ventricular ejection fraction (adjusted HR 0.97, P=0.027) and estimated glomerular filtration rate (adjusted HR 0.98, P=0.016), but not baseline tricuspid regurgitation severity.

Structured PICO

Does baseline massive or torrential tricuspid regurgitation worsen mortality, heart failure readmission, and postoperative regurgitation grade compared to severe tricuspid regurgitation in symptomatic patients undergoing tricuspid valve surgery?

P

Population

164 symptomatic patients (mean age 71.2 ± 10.4 years [abstract] or 71 ± 11 years [full text], 46% male) with severe (n=69, 42%, vena contracta width 7-14 mm) or massive/torrential tricuspid regurgitation (n=95, 58%, vena contracta width ≥14 mm) undergoing isolated (n=34) or concomitant (n=130) tricuspid valve surgery (repair or replacement) at a single center (National Cerebral and Cardiovascular Center hospital) between January 2010 and August 2024. Excluded patients with moderate or less TR, concomitant intracardiac repair for congenital heart disease, or planned implantation of a ventricular assist device.

I

Intervention

Tricuspid valve surgery (repair or replacement) in patients with massive or torrential tricuspid regurgitation (vena contracta width ≥14 mm, n=95), performed via sternotomy or right thoracotomy under cardiopulmonary bypass, either isolated or with concomitant cardiac procedures (primarily mitral valve surgery).

C

Comparator

Tricuspid valve surgery (repair or replacement) in patients with severe tricuspid regurgitation (vena contracta width 7-14 mm, n=69), either isolated or with concomitant cardiac procedures.

O

Outcome

All-cause mortality (stated in full text Methods; note: abstract states postoperative tricuspid regurgitation grade was the primary endpoint) over a mean follow-up of 4.6 ± 3.9 years (maximum 14.8 years).hard clinical

Tricuspid valve surgery for massive or torrential tricuspid regurgitation achieves low perioperative mortality and favorable 5-year survival comparable to surgery for severe TR, with long-term prognosis driven by baseline left ventricular and renal function rather than preoperative TR grade.

Limitations

Incomplete right ventricular parameters (tricuspid annular diameter and RV fractional area change) in earlier cases prior to 2019 due to limited availability of stored echocardiographic clips
Limited number of events restricting the number of covariates in multivariable models
Heterogeneity of the cohort, including high prevalence of concomitant procedures (particularly mitral valve surgery) as well as both primary and functional TR
Lack of comprehensive preoperative right-heart hemodynamic data limiting the comparison between tricuspid valve repair and replacement

Implication

May support surgery for massive/torrential TR with outcomes akin to severe disease; leaves open causal benefit and role of baseline factors.

Abstract

Objective Massive or torrential tricuspid regurgitation is associated with poor survival; however, its impact on surgical results remains uncertain. Outcomes following tricuspid valve surgery in patients with severe versus massive or torrential tricuspid regurgitation were compared. Methods From 2010-2024, 164 symptomatic patients (mean age 71.2 ± 10.4 years) with severe (n = 69, 42%) or massive/torrential tricuspid regurgitation (n = 95, 58%) underwent tricuspid valve surgery, with or without concomitant procedures. Postoperative tricuspid regurgitation grade was the primary endpoint. Mortality and heart failure hospitalization predictors were analyzed. The mean follow-up was 4.6 ± 3.9 years. Results Tricuspid repair was performed more frequent in patients with severe than with massive/torrential tricuspid regurgitation (96% vs 80%, P=0.004). In-hospital mortality rates were 0% and 2.1%, respectively (P = 0.51). Postoperatively, tricuspid regurgitation improved significantly in both groups, with similar rates of residual tricuspid regurgitation ≤ mild (73.9% vs 72.3%, P=0.91). During the follow-up period, 26 patients died and 38 were re-hospitalized for heart failure. Five-year survival was similar between the groups (85% vs. 81%, P=0.36). Higher left ventricular ejection fraction (adjusted hazard ratio 0.97, P=0.027) and estimated glomerular filtration rate (adjusted hazard ratio 0.98, P=0.016) were independently protective for adverse outcomes, whereas baseline tricuspid regurgitation severity was not. Conclusions Tricuspid valve surgery for severe or massive/torrential tricuspid regurgitation can be performed with low perioperative mortality, and provides favorable long-term outcomes. Prognosis is determined primarily by baseline cardiac and renal function, rather than preoperative tricuspid regurgitation severity.

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Cite This Study

Sakurai et al. (2026) studied this question.

synapsesocial.com/papers/6a824aa4720902ef11795541 https://doi.org/10.1016/j.xjon.2026.101944

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Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Isolated or concomitant tricuspid valve surgery for massive or torrential tricuspid regurgitation

Figures

Key Points

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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