Author + information
- Received January 8, 2019
- Revision received April 10, 2019
- Accepted April 25, 2019
- Published online August 5, 2019.
- Andrea L. Axtell, MD, MPHa,b,
- Vijeta Bhambhani, MS, MPHc,
- Philicia Moonsamy, MDa,d,
- Emma W. Healy, BSc,
- Michael H. Picard, MDc,
- Thoralf M. Sundt III, MDa and
- Jason H. Wasfy, MD, MPhilc,∗ (, )@jasonwasfy
- aCorrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
- bMinehan Outcomes Fellowship Program, Corrigan Minehan Heart Center, Boston, Massachusetts
- cDivision of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- dMartignetti Outcomes Fellowship Program, Division of Cardiac Surgery, Massachusetts General Hospital, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Jason H. Wasfy, Massachusetts General Hospital, 55 Fruit Street, Boston, Massachusetts 02114.
Background Patients with isolated tricuspid regurgitation (TR) in the absence of left-sided valvular dysfunction are often managed nonoperatively.
Objectives The purpose of this study was to assess the impact of surgery for isolated TR, comparing survival for isolated severe TR patients who underwent surgery with those who did not.
Methods A longitudinal echocardiography database was used to perform a retrospective analysis of 3,276 adult patients with isolated severe TR from November 2001 to March 2016. All-cause mortality for patients who underwent surgery versus those who did not was analyzed in the entire cohort and in 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 (hazard ratio: 1.34; 95% confidence interval: 0.78 to 2.30; p = 0.288). In the subgroup that underwent surgery, there was no difference in survival between tricuspid repair versus replacement (hazard ratio: 1.53; 95% confidence interval: 0.74 to 3.17; p = 0.254).
Conclusions 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.
This work was funded in part from grants from the American Heart Association (18 CDA 34110215), the National Institutes of Health and Harvard Catalyst (KL2 TR001100), and the Massachusetts General Hospital Corrigan Minehan Heart Center SPARK grant, all awarded to Dr. Wasfy. Dr. Bhambhani is a full-time employee at ICON plc (a contract research organization). Dr. Sundt has served on the Clinical Events Committee for Medpace. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This work was presented at the AATS Annual Meeting, Toronto, Ontario, Canada, May 2019.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received January 8, 2019.
- Revision received April 10, 2019.
- Accepted April 25, 2019.
- 2019 American College of Cardiology Foundation
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