Author + information
- Received January 8, 2019
- Revision received April 10, 2019
- Accepted April 25, 2019
- Published online May 6, 2019.
- Andrea L. Axtell, MDa,c,
- Vijeta Bhambhani, MS, MPHb,
- Philicia Moonsamy, MDa,d,
- Emma W. Healy, BSb,
- Michael H. Picard, MDb,
- Thoralf M. Sundt, MDa and
- Jason H. Wasfy, MDb,∗ (, )@jasonwasfy
- aCorrigan Minehan Heart Center and Division of Cardiac Surgery, Massachusetts General HospitalCorrigan Minehan Heart Center and Division of Cardiac Surgery; Massachusetts General Hospital
- bDivision of Cardiology, Department of Medicine, Massachusetts General HospitalDivision of Cardiology, Department of Medicine, Massachusetts General Hospital
- cMinehan Outcomes Fellow, Corrigan Minehan Heart CenterMinehan Outcomes Fellow, Corrigan Minehan Heart Center
- dMartignetti Outcomes Fellow, Division of Cardiac SurgeryMartignetti Outcomes Fellow, Division of Cardiac Surgery
- ↵∗Corresponding Author: Jason H. Wasfy, MD, MPhil Massachusetts General Hospital 55 Fruit Street Boston, MA 02114 Telephone: 617-726-2000 Fax: 617-726-5804.
Background Patients with isolated tricuspid regurgitation (TR) in the absence of left-sided valvular dysfunction are historically managed nonoperatively.
Objectives To assess the impact of surgery for isolated TR, we compared survival for isolated severe TR patients who underwent surgery to those who did not.
Methods A longitudinal echocardiography database was used to perform a retrospective analysis on 3,276 adult patients with isolated severe TR from November 2001-March 2016. All-cause mortality for patients who underwent surgery versus those who did not was analyzed in the entire cohort and 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 (HR 1.34 [0.78-2.30], p=0.288). In the subgroup that underwent surgery, there was no difference in survival between tricuspid repair versus replacement (HR 1.53 [0.74-3.17], p=0.254).
Conclusion 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.
Funding: 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.
Disclosures: None of the authors have a relevant conflict of interest to disclose.
Meeting Presentation: Presented at the AATS Annual Meeting, Toronto, Canada, May 2019
Tweet: “In patients with isolated severe tricuspid regurgitation, surgery is not associated with improved survival compared to medical therapy alone.”
- Received January 8, 2019.
- Revision received April 10, 2019.
- Accepted April 25, 2019.
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