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

Autor:	Dreyfus J; Department of Cardiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, 93200 Saint-Denis, France., Juarez-Casso F; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MM, USA., Sala A; Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Carnero-Alcazar M; Department of Cardiac Surgery, Hospital Clínico San Carlos, Madrid, Spain., Eixerés-Esteve A; Cardiac Surgery Department, Hospital 12 de Octubre, Madrid, Spain., Bohbot Y; Department of Cardiology, Amiens University Hospital, Amiens, France.; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France., Bazire B; Department of Cardiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, 93200 Saint-Denis, France., Flagiello M; Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, Bron, France., Riant E; Department of Cardiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, 93200 Saint-Denis, France., Mbaki Y; Cardiology Department, LTSI UMR1099, INSERM, Université de Rennes-1, CHU de RENNES, Rennes, France., Tomasi J; Department of Cardiac Surgery, CHU de RENNES, Université de Rennes-1, Rennes, France., Senage T; Department of Cardiac Surgery, INSERM 1246, Université de Nantes, CHU de Nantes, Nantes, France., Rahmouni El Idrissi K; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Coisne A; Department of Clinical Physiology and Echocardiography-Heart Valve Clinic, CHU Lille, Lille, France.; Institut Pasteur de Lille, U1011-EGID, Univ. Lille, Inserm, CHU Lille, Lille, France., Eyharts D; Heart Valve Center, Toulouse University Hospital, Toulouse, France., Doguet F; Department of Cardiology and Cardiovascular Surgery, CHU Charles Nicolle, Rouen, France., Viau F; Cardiology Department, APHM, La Timone Hospital, Marseille, France., Eggenspieler F; Cardiology Department, CHU Nancy-Brabois, Nancy, France., Heuts S; Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands., Sardari Nia P; Department of Cardiothoracic Surgery, Maastricht University Medical Center (MUMC+), Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), University Maastricht, Maastricht, The Netherlands., Heitzinger G; Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria., Galloo X; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.; Department of Cardiology, Free University Brussels (VUB), University Hospital Brussels (UZ Brussel), Brussels, Belgium., Ajmone Marsan N; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Benfari G; Cardiovascular Disease Department, Mayo Clinic, Rochester, MM, USA.; Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy., Badano L; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Muraru D; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy.; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy., Maisano F; Cardiac Surgery and Heart Valve Center, Ospedale San Raffaele, University Vita Salute, Milano, Italy., Topilsky Y; Department of Cardiology, Tel Aviv Medical Center, Sackler Faculty of Medicine, Tel Aviv, Israel., Michelena H; Cardiovascular Disease Department, Mayo Clinic, Rochester, MM, USA., Enriquez-Sarano M; Valve Science Center, Minneapolis Heart Institute, Minneapolis, MN, USA., Bax J; Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands., Bartko P; Department for Internal Medicine II, Cardiology, Medical University of Vienna, Vienna, Austria., Selton-Suty C; Cardiology Department, CHU Nancy-Brabois, Nancy, France., Habib G; Cardiology Department, APHM, La Timone Hospital, Marseille, France., Lavie-Badie Y; Heart Valve Center, Toulouse University Hospital, Toulouse, France., Modine T; Department of Cardiology and Cardiovascular Surgery, Hôpital Cardiologique de Haut-Leveque, Bordeaux University Hospital, Bordeaux, France., Chan V; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Le Tourneau T; CNRS, INSERM, l'institut du thorax, Université de Nantes, CHU de Nantes, Nantes, France., Donal E; Cardiology Department, LTSI UMR1099, INSERM, Université de Rennes-1, CHU de RENNES, Rennes, France., Lim P; Cardiology Department, Expert Valve Center, Henri Mondor Hospital, Créteil, France., Radu C; Department of Cardiac Surgery, AP-HP, Henri Mondor Hospital, Créteil, France., Bernick J; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Wells GA; Cardiovascular Research Methods Center, University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Tribouilloy C; Department of Cardiology, Amiens University Hospital, Amiens, France.; UR UPJV 7517, Jules Verne University of Picardie, Amiens, France., Iung B; Cardiology Department, Bichat Hospital, APHP, and INSERM LVTS U1148, Université de Paris, ParisFrance., Obadia JF; Department of Cardiovascular Surgery and Transplantation, Louis Pradel Cardiovascular Hospital, Claude Bernard University, Bron, France., De Bonis M; Department of Cardiac Surgery, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy., Crestanello J; Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MM, USA., Messika-Zeitoun D; Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada.
Jazyk:	angličtina
Zdroj:	European heart journal [Eur Heart J] 2024 Nov 08; Vol. 45 (42), pp. 4512-4522.
DOI:	10.1093/eurheartj/ehae578
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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