Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement

Previous studies have compared the outcomes of mitral annuloplasty with those of mitral valve replacement in patients with functional mitral regurgitation. However, data comparing the results of tricuspid annuloplasty (TAP) with those of tricuspid valve replacement (TVR) in patients with functional tricuspid regurgitation (FTR) have been scarce. We evaluated whether TAP was an optimal option for severe FTR. From 1996 to 2012, 175 patients (57 +/- 11 years old) underwent surgical correction for severe FTR. A total of 108 patients underwent TAP (the TAP group), and 67 underwent TVR (the TVR group). Inverse probability of treatment weighting (IPTW) analysis and propensity score matching with 37 patients in each group were performed to adjust for the baseline differences between the two groups. Early mortality occurred in 13 patients without any inter-group differences. There were 35 late mortalities, including 24 cardiac deaths. The 5- and 10-year freedom rates from cardiac death were 93.0 and 88.5%, respectively, in the TAP group, and 84.7 and 69.8%, respectively, in the TVR group. The IPTW-adjusted multivariable analysis revealed that the freedom rates from cardiac death were higher in the TAP group than in the TVR group (P = 0.01). In the propensity score-matched patients, the freedom rates from cardiac death and tricuspid valve-related event were higher in the TAP group than in the TVR group, although the difference was not statistically significant. TAP should be considered as a treatment of choice for patients with severe FTR because TVR has been associated with long-term cardiac death and valve-related events.