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Surgery for isolated tricuspid regurgitation does not improve survival

13 Aug 2019

Surgery in patients with isolated severe tricuspid regurgitation (TR) does not seem to lead to better long-term survival compared to medical management alone after accounting for immortal time bias, a recent study has shown.

A total of 3,276 patients with isolated severe TR were identified, of whom 171 (5 percent) underwent tricuspid valve surgery, including 143 (84 percent) repairs and 28 (16 percent) replacements. The remaining patients (n=3,105; 95 percent) were medically managed.

When surgery was considered as a time-dependent covariate in a propensity-matched sample, no difference was observed in overall survival between patients who received medical therapy and those who received surgical treatment (hazard ratio [HR], 1.34, 95 percent CI, 0.78–2.30; p=0.288).

Among patients who underwent surgery, no difference was also seen in terms of survival between tricuspid repair and replacement (HR, 1.53, 0.74–3.17; p=0.254).

This study examined the effect of surgery for isolated TR in terms of survival. The authors used a longitudinal echocardiography database to perform a retrospective analysis of 3,276 adult patients with isolated severe TR from November 2001 to March 2016. They analysed all-cause mortality for patients who underwent surgery vs those who did not in the entire cohort and in a propensity-matched sample. The possibility of immortal time bias was assessed in an analysis that considered time from diagnosis to surgery as a time-dependent covariate.

“Patients with isolated TR in the absence of left-sided valvular dysfunction are often managed nonoperatively,” the authors said.

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