Shedding some light on tricuspid intervention

BACKGROUND: More than 1.6 million Americans have at least moderate to severe valvular tricuspid regurgitation, yet fewer than 8000 tricuspid valve operations are performed annually in the USA. The undertreatment for isolated tricuspid regurgitation might be related to the fact that in the past years no clear guidelines on 'how' and 'when' to treat tricuspid regurgitation were issued. AIMS: Sarris-Michopoulos and colleagues carried out a meta-analysis with the aim to investigate the role of tricuspid valve repair versus tricuspid valve replacement in patients with isolated tricuspid valve regurgitation. MATERIAL AND METHODS: Outcomes of patients with first-time surgery for isolated tricuspid valve regurgitation without previous left-sided valve surgery were reviewed. Ten studies were included with a total of 1407 patients. RESULTS: Authors concluded that patients who underwent tricuspid valve repair showed less 30-days mortality than replacement along with a reduced need for post-operaitve permanent pacemaker implantation rate. DISCUSSION: Decision on whether to treat or not tricuspid valve is demanding, particularly in the context of the newest percutaneous technologies. Before intervention, careful evaluation of both tricuspid valve and right ventricle must be performed. Nevertheless, intervention, should not be deferred when clinically indicated. CONCLUSIONS: The findings form this meta-analysis suggest that reparative surgery, perhaps in an early stage, may be beneficial in selected cohort of patients.