Department of Cardiology, Centre Cardiologique du Nord, 32-36 rue des moulins gémeaux, 93200 Saint-Denis, France.
Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MM, USA.
Eur Heart J. 2024 Nov 8;45(42):4512-4522. doi: 10.1093/eurheartj/ehae578.
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.
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).
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).
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.
严重三尖瓣反流与死亡率增加相关，但尚未明确其矫正的益处和理想时机。本研究旨在确定可能从手术中获益的患者亚组。
在 TRIGISTRY 中，一项国际多中心连续严重孤立性功能性三尖瓣反流患者队列研究（33 个中心，10 个国家），比较了接受单纯三尖瓣瓣膜手术（修复或置换）与保守治疗的患者的 10 年生存率，整体和根据 TRI-SCORE 分类（低：≤3，中：4-5，高：≥6）。
1217 例患者接受保守治疗，551 例接受单纯三尖瓣瓣膜手术（200 例修复和 351 例置换）。TRI-SCORE 分布为 33%低，32%中，35%高。10 年时，手术组和保守治疗组的生存率相似[41% vs. 36%；风险比（HR）.97；95%置信区间（CI）.88-1.08，P =.57]。在低 TRI-SCORE 类别中，手术治疗与保守治疗相比，生存率得到改善（72% vs. 44%；HR.27；95% CI.20-.37，P <.0001），但在中（36% vs. 37%；HR 1.17；95%CI.98-1.40，P =.09）或高（20% vs. 24%；HR 1.06；95% CI.91-1.25，P =.45）类别中无差异。低 TRI-SCORE 类别中，修复和置换均可改善生存率（84%和 61% vs. 44%；HR.11；95% CI.06-.19，P <.0001 和 HR.65；95% CI.47-.90，P =.009）。修复在中类别中显示出获益（59% vs. 37%；HR.49；95% CI.35-.68，P <.0001），而置换可能有害（25% vs. 37%；HR 1.43；95% CI 1.18-1.72，P =.0002）。
修复的生存率高于置换，随着 TRI-SCORE 的增加，干预的获益降低，高 TRI-SCORE 类别中任何类型手术均无获益。这些结果强调了及时干预和患者选择的重要性，以实现最佳结局，并需要进行随机对照试验。
