Korean Circ J.  2023 Nov;53(11):775-786. 10.4070/kcj.2023.0108.

Tricuspid Edge-to-Edge Repair Versus Tricuspid Valve Replacement for Severe Tricuspid Regurgitation

• Kim J
• Lee H
• Jung JH
• Yoo JS

• KMID: 2548240
• DOI: http://doi.org/10.4070/kcj.2023.0108

Abstract

Background and Objectives
Tricuspid valve (TV) repair techniques other than annuloplasty remain challenging and frequently end in tricuspid valve replacement (TVR) in complicated cases. However, the results of TVR are suboptimal compared with TV repair. This study aimed to evaluate the clinical effectiveness of TV edge-to-edge repair (E2E) compared to TVR for severe tricuspid regurgitation (TR).
Methods
We retrospectively reviewed 230 patients with severe TR who underwent E2E (n=139) or TVR (n=91) from 2001 to 2020. Clinical and echocardiographic results were analyzed using inverse probability of treatment weighting analysis and propensity score matching.
Results
The two groups showed no significant differences in early mortality and morbidities. During the mean follow-up of 106.2±68.8 months, late severe TR and TV reoperation rates were not significantly different between groups. E2E group, however, showed better outcomes in overall survival (p=0.023), freedom from significant tricuspid stenosis (TS) (trans-tricuspid pressure gradient ≥5 mmHg, p=0.021), and freedom from TVrelated events (p<0.001). Matched analysis showed consistent results.
Conclusions
E2E for severe TR presented more favorable clinical outcomes than TVR. Our study supports that E2E might be a valuable option in severe TR surgery, avoiding TVR.

Keyword

Tricuspid valve; Tricuspid valve insufficiency; Heart valve disease; Heart valve prosthesis; Heart valve prosthesis implantation

Figure

• 

  Figure 1 IPTW-adjusted Kaplan-Meier curves of the E2E and TVR groups for overall mortality.E2E = edge-to-edge repair; IPTW = inverse probability of treatment weighting; TVR = tricuspid valve replacement.

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  Figure 2 IPTW-adjusted Kaplan-Meier curves of the E2E and TVR groups for TV-related events (A), late severe TR (B), late significant TS defined as TTPG ≥5 mmHg (C), and tricuspid reoperation (D).E2E = edge-to-edge repair; IPTW = inverse probability of treatment weighting; TR = tricuspid regurgitation; TS = tricuspid stenosis; TTPG = trans-tricuspid pressure gradient; TVR = tricuspid valve replacement.

• 

  Figure 3 Forest plots of HRs for overall mortality and composite events, including overall mortality, late severe TR, late significant TS, and tricuspid reoperations comparing the E2E and TVR groups during the follow-up period using the Cox proportional hazard models. Analyses are performed with multivariable Cox regression, IPTW-adjusted analysis, and PS-matched analysis.CI = confidence interval; E2E = edge-to-edge repair; HR = hazard ratio; IPTW = inverse probability of treatment weighting; PS = propensity score; TR = tricuspid regurgitation; TS = tricuspid stenosis; TTPG = trans-tricuspid pressure gradient; TVR = tricuspid valve replacement.

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