Research progress on the treatment of isolated tricuspid regurgitation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HU Yuanyu ,  SUN Hansong

Department of Cardiovascular Surgery, Fuwai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100037, P.R.China;

Corresponding author：

SUN Hansong, Email: shs1505@sina.com

Keywords：

Isolated tricuspid regurgitation; surgery; transcatheter treatment; review

DOI：

10.7507/1007-4848.201910025

Video：

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With the prevalence of atrial fibrillation and the increasing use of intracardiac pacemakers, the incidence of isolated tricuspid regurgitation is gradually increasing. Severe isolated tricuspid regurgitation has a seriously negative effect on the survival rate and life quality of patients. As the major invasive therapy, surgery is not routinely carried out due to high perioperative mortality. This article attempts to summarize the etiology, natural course and adverse consequences of isolated tricuspid regurgitation, current treatment strategies, surgical indications and techniques, efficacy evaluation, prognostic factors and transcatheter treatment progress of isolated tricuspid regurgitation, aiming to provide references for cardiologists and further researches.

Citation： HU Yuanyu, SUN Hansong. Research progress on the treatment of isolated tricuspid regurgitation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(6): 704-709. doi: 10.7507/1007-4848.201910025 Copy

1.	Stephens EH, Borger MA. "Forgotten" valve or "enigmatic" valve? Further insights into the tricuspid valve in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2014, 148(5): 1962-1964.
2.	Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
3.	Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging, 2014, 7(12): 1185-1194.
4.	Paniagua D, Aldrich HR, Lieberman EH, et al. Increased prevalence of significant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol, 1998, 82(9): 1130-1139.
5.	Sadeghpour A, Hassanzadeh M, Kyavar M, et al. Impact of severe tricuspid regurgitation on long term survival. Res Cardiovasc Med, 2013, 2(3): 121-126.
6.	Höke U, Auger D, Thijssen J, et al. Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up. Heart, 2014, 100(12): 960-968.
7.	Mutlak D, Lessick J, Reisner SA, et al. Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20(4): 405-408.
8.	Chang JD, Manning WJ, Ebrille E, et al. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol, 2017, 69(18): 2331-2341.
9.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): 1-132.
10.	Andersen MJ, Nishimura RA, Borlaug BA. The hemodynamic basis of exercise intolerance in tricuspid regurgitation. Circ Heart Fail, 2014, 7(6): 911-917.
11.	Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. J Card Fail, 2008, 14(10): 824-830.
12.	Lau GT, Tan HC, Kritharides L. Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation. Am J Cardiol, 2002, 90(12): 1405-1409.
13.	Hung J, Koelling T, Semigran MJ, et al. Usefulness of echocardiographic determined tricuspid regurgitation in predicting event-free survival in severe heart failure secondary to idiopathic-dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol, 1998, 82(10): 1301-1303.
14.	Ruel M, Rubens FD, Masters RG, et al. Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves. J Thorac Cardiovasc Surg, 2004, 128(2): 278-283.
15.	Messika-Zeitoun D, Thomson H, Bellamy M, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg, 2004, 128(2): 296-302.
16.	Fender EA, Petrescu I, Ionescu F, et al. Prognostic importance and predictors of survival in isolated tricuspid regurgitation: A growing problem. Mayo Clin Proc, 2019, 94(10): 2032-2039.
17.	Takahashi Y, Izumi C, Miyake M, et al. Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease. Int J Cardiol, 2017, 243: 251-257.
18.	Nishimura K, Okayama H, Inoue K, et al. Visualization of traumatic tricuspid insufficiency by three-dimensional echocardiography. J Cardiol, 2010, 55(1): 143-146.
19.	Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
20.	Taylor J. ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J, 2012, 33(19): 2371-2372.
21.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 57-185.
22.	Moraca RJ, Moon MR, Lawton JS, et al. Outcomes of tricuspid valve repair and replacement: a propensity analysis. Ann Thorac Surg, 2009, 87(1): 83-89.
23.	Hwang HY, Kim KH, Kim KB, et al. Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement. Eur J Cardiothorac Surg, 2014, 46(2): 21-27.
24.	Shinn SH, Schaff HV. Evidence-based surgical management of acquired tricuspid valve disease. Nat Rev Cardiol, 2013, 10(4): 190-203.
25.	Marquis-Gravel G, Bouchard D, Perrault LP, et al. Retrospective cohort analysis of 926 tricuspid valve surgeries: clinical and hemodynamic outcomes with propensity score analysis. Am Heart J, 2012, 163(5): 851-858.
26.	McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
27.	Mangoni AA, DiSalvo TG, Vlahakes GJ, et al. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg, 2001, 19(1): 68-73.
28.	Silva M, Cerejo R, Coelho P, et al. Isolated tricuspid valve surgery: repair versus replacement. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 122.
29.	Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2953-2960.
30.	Moutakiallah Y, Aithoussa M, Atmani N, et al. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg, 2018, 13(1): 104.
31.	Pfannmuller B, Doenst T, Eberhardt K, et al. Increased risk of dehiscence after tricuspid valve repair with rigid annuloplasty rings. J Thorac Cardiovasc Surg, 2012, 143(5): 1050-1055.
32.	Wang H, Liu X, Wang X, et al. Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease. J Thorac Dis, 2016, 8(11): 3087-3095.
33.	Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
34.	Tornos Mas P, Rodriguez-Palomares JF, Antunes MJ. Secondary tricuspid valve regurgitation: a forgotten entity. Heart, 2015, 101(22): 1840-1848.
35.	Sarralde JA, Bernal JM, Llorca J, et al. Repair of rheumatic tricuspid valve disease: predictors of very long-term mortality and reoperation. Ann Thorac Surg, 2010, 90(2): 503-508.
36.	Liu P, Qiao WH, Sun FQ, et al. Should a mechanical or biological prosthesis be used for a tricuspid valve replacement? A meta-analysis. J Card Surg, 2016, 31(5): 294-302.
37.	Cho WC, Park CB, Kim JB, et al. Mechanical valve replacement versus bioprosthetic valve replacement in the tricuspid valve position. J Card Surg, 2013, 28(3): 212-217.
38.	Liang W, Yue H, Li T, et al. The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation. Anatol J Cardiol, 2019, 22(4): 172-176.
39.	Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
40.	Hamandi M, Smith RL, Ryan WH, et al. Outcomes of isolated tricuspid valve surgery have improved in the modern era. Ann Thorac Surg, 2019, 108(1): 11-15.
41.	Ejiofor JI, Neely RC, Yammine M, et al. Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement. Ann Cardiothorac Surg, 2017, 6(3): 214-222.
42.	Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis, 1999, 8(5): 567-574.
43.	Lee JW, Song JM, Park JP, et al. Long-term prognosis of isolated significant tricuspid regurgitation. Circ J, 2010, 74(2): 375-380.
44.	Axtell AL, Bhambhani V, Moonsamy P, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(6): 715-725.
45.	O'Gara PT, Gillinov M, Rodes-Cabau J. Surgery for isolated tricuspid regurgitation: limitations of observational analyses. J Am Coll Cardiol, 2019, 74(6): 726-728.
46.	Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
47.	Asmarats L, Puri R, Rodes-Cabau J. Transcatheter treatment of functional tricuspid regurgitation: preliminary experiences. Minerva Cardioangiol, 2017, 65(5): 504-515.
48.	Kefer J, Sluysmans T, Vanoverschelde JL. Transcatheter Sapien valve implantation in a native tricuspid valve after failed surgical repair. Catheter Cardiovasc Interv, 2014, 83(5): 841-845.
49.	Navia JL, Kapadia S, Elgharably H, et al. First-in-human implantations of the navigate bioprosthesis in a severely dilated tricuspid annulus and in a failed tricuspid annuloplasty ring. Circ Cardiovasc Interv, 2017, 10(12): e005840.

1. Stephens EH, Borger MA. "Forgotten" valve or "enigmatic" valve? Further insights into the tricuspid valve in patients undergoing mitral valve surgery. J Thorac Cardiovasc Surg, 2014, 148(5): 1962-1964.
2. Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol, 2004, 43(3): 405-409.
3. Topilsky Y, Nkomo VT, Vatury O, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging, 2014, 7(12): 1185-1194.
4. Paniagua D, Aldrich HR, Lieberman EH, et al. Increased prevalence of significant tricuspid regurgitation in patients with transvenous pacemakers leads. Am J Cardiol, 1998, 82(9): 1130-1139.
5. Sadeghpour A, Hassanzadeh M, Kyavar M, et al. Impact of severe tricuspid regurgitation on long term survival. Res Cardiovasc Med, 2013, 2(3): 121-126.
6. Höke U, Auger D, Thijssen J, et al. Significant lead-induced tricuspid regurgitation is associated with poor prognosis at long-term follow-up. Heart, 2014, 100(12): 960-968.
7. Mutlak D, Lessick J, Reisner SA, et al. Echocardiography-based spectrum of severe tricuspid regurgitation: the frequency of apparently idiopathic tricuspid regurgitation. J Am Soc Echocardiogr, 2007, 20(4): 405-408.
8. Chang JD, Manning WJ, Ebrille E, et al. Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation. J Am Coll Cardiol, 2017, 69(18): 2331-2341.
9. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Thorac Cardiovasc Surg, 2014, 148(1): 1-132.
10. Andersen MJ, Nishimura RA, Borlaug BA. The hemodynamic basis of exercise intolerance in tricuspid regurgitation. Circ Heart Fail, 2014, 7(6): 911-917.
11. Maeder MT, Holst DP, Kaye DM. Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure. J Card Fail, 2008, 14(10): 824-830.
12. Lau GT, Tan HC, Kritharides L. Type of liver dysfunction in heart failure and its relation to the severity of tricuspid regurgitation. Am J Cardiol, 2002, 90(12): 1405-1409.
13. Hung J, Koelling T, Semigran MJ, et al. Usefulness of echocardiographic determined tricuspid regurgitation in predicting event-free survival in severe heart failure secondary to idiopathic-dilated cardiomyopathy or to ischemic cardiomyopathy. Am J Cardiol, 1998, 82(10): 1301-1303.
14. Ruel M, Rubens FD, Masters RG, et al. Late incidence and predictors of persistent or recurrent heart failure in patients with mitral prosthetic valves. J Thorac Cardiovasc Surg, 2004, 128(2): 278-283.
15. Messika-Zeitoun D, Thomson H, Bellamy M, et al. Medical and surgical outcome of tricuspid regurgitation caused by flail leaflets. J Thorac Cardiovasc Surg, 2004, 128(2): 296-302.
16. Fender EA, Petrescu I, Ionescu F, et al. Prognostic importance and predictors of survival in isolated tricuspid regurgitation: A growing problem. Mayo Clin Proc, 2019, 94(10): 2032-2039.
17. Takahashi Y, Izumi C, Miyake M, et al. Actual management and prognosis of severe isolated tricuspid regurgitation associated with atrial fibrillation without structural heart disease. Int J Cardiol, 2017, 243: 251-257.
18. Nishimura K, Okayama H, Inoue K, et al. Visualization of traumatic tricuspid insufficiency by three-dimensional echocardiography. J Cardiol, 2010, 55(1): 143-146.
19. Zoghbi WA, Enriquez-Sarano M, Foster E, et al. Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography. J Am Soc Echocardiogr, 2003, 16(7): 777-802.
20. Taylor J. ESC/EACTS Guidelines on the management of valvular heart disease. Eur Heart J, 2012, 33(19): 2371-2372.
21. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): 57-185.
22. Moraca RJ, Moon MR, Lawton JS, et al. Outcomes of tricuspid valve repair and replacement: a propensity analysis. Ann Thorac Surg, 2009, 87(1): 83-89.
23. Hwang HY, Kim KH, Kim KB, et al. Treatment for severe functional tricuspid regurgitation: annuloplasty versus valve replacement. Eur J Cardiothorac Surg, 2014, 46(2): 21-27.
24. Shinn SH, Schaff HV. Evidence-based surgical management of acquired tricuspid valve disease. Nat Rev Cardiol, 2013, 10(4): 190-203.
25. Marquis-Gravel G, Bouchard D, Perrault LP, et al. Retrospective cohort analysis of 926 tricuspid valve surgeries: clinical and hemodynamic outcomes with propensity score analysis. Am Heart J, 2012, 163(5): 851-858.
26. McCarthy PM, Bhudia SK, Rajeswaran J, et al. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg, 2004, 127(3): 674-685.
27. Mangoni AA, DiSalvo TG, Vlahakes GJ, et al. Outcome following isolated tricuspid valve replacement. Eur J Cardiothorac Surg, 2001, 19(1): 68-73.
28. Silva M, Cerejo R, Coelho P, et al. Isolated tricuspid valve surgery: repair versus replacement. Rev Port Cir Cardiotorac Vasc, 2017, 24(3-4): 122.
29. Zack CJ, Fender EA, Chandrashekar P, et al. National trends and outcomes in isolated tricuspid valve surgery. J Am Coll Cardiol, 2017, 70(24): 2953-2960.
30. Moutakiallah Y, Aithoussa M, Atmani N, et al. Reoperation for isolated rheumatic tricuspid regurgitation. J Cardiothorac Surg, 2018, 13(1): 104.
31. Pfannmuller B, Doenst T, Eberhardt K, et al. Increased risk of dehiscence after tricuspid valve repair with rigid annuloplasty rings. J Thorac Cardiovasc Surg, 2012, 143(5): 1050-1055.
32. Wang H, Liu X, Wang X, et al. Comparison of outcomes of tricuspid annuloplasty with 3D-rigid versus flexible prosthetic ring for functional tricuspid regurgitation secondary to rheumatic mitral valve disease. J Thorac Dis, 2016, 8(11): 3087-3095.
33. Navia JL, Nowicki ER, Blackstone EH, et al. Surgical management of secondary tricuspid valve regurgitation: annulus, commissure, or leaflet procedure? J Thorac Cardiovasc Surg, 2010, 139(6): 1473-1482.
34. Tornos Mas P, Rodriguez-Palomares JF, Antunes MJ. Secondary tricuspid valve regurgitation: a forgotten entity. Heart, 2015, 101(22): 1840-1848.
35. Sarralde JA, Bernal JM, Llorca J, et al. Repair of rheumatic tricuspid valve disease: predictors of very long-term mortality and reoperation. Ann Thorac Surg, 2010, 90(2): 503-508.
36. Liu P, Qiao WH, Sun FQ, et al. Should a mechanical or biological prosthesis be used for a tricuspid valve replacement? A meta-analysis. J Card Surg, 2016, 31(5): 294-302.
37. Cho WC, Park CB, Kim JB, et al. Mechanical valve replacement versus bioprosthetic valve replacement in the tricuspid valve position. J Card Surg, 2013, 28(3): 212-217.
38. Liang W, Yue H, Li T, et al. The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation. Anatol J Cardiol, 2019, 22(4): 172-176.
39. Vassileva CM, Shabosky J, Boley T, et al. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg, 2012, 143(5): 1043-1049.
40. Hamandi M, Smith RL, Ryan WH, et al. Outcomes of isolated tricuspid valve surgery have improved in the modern era. Ann Thorac Surg, 2019, 108(1): 11-15.
41. Ejiofor JI, Neely RC, Yammine M, et al. Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement. Ann Cardiothorac Surg, 2017, 6(3): 214-222.
42. Staab ME, Nishimura RA, Dearani JA. Isolated tricuspid valve surgery for severe tricuspid regurgitation following prior left heart valve surgery: analysis of outcome in 34 patients. J Heart Valve Dis, 1999, 8(5): 567-574.
43. Lee JW, Song JM, Park JP, et al. Long-term prognosis of isolated significant tricuspid regurgitation. Circ J, 2010, 74(2): 375-380.
44. Axtell AL, Bhambhani V, Moonsamy P, et al. Surgery does not improve survival in patients with isolated severe tricuspid regurgitation. J Am Coll Cardiol, 2019, 74(6): 715-725.
45. O'Gara PT, Gillinov M, Rodes-Cabau J. Surgery for isolated tricuspid regurgitation: limitations of observational analyses. J Am Coll Cardiol, 2019, 74(6): 726-728.
46. Kuwaki K, Morishita K, Tsukamoto M, et al. Tricuspid valve surgery for functional tricuspid valve regurgitation associated with left-sided valvular disease. Eur J Cardiothorac Surg, 2001, 20(3): 577-582.
47. Asmarats L, Puri R, Rodes-Cabau J. Transcatheter treatment of functional tricuspid regurgitation: preliminary experiences. Minerva Cardioangiol, 2017, 65(5): 504-515.
48. Kefer J, Sluysmans T, Vanoverschelde JL. Transcatheter Sapien valve implantation in a native tricuspid valve after failed surgical repair. Catheter Cardiovasc Interv, 2014, 83(5): 841-845.
49. Navia JL, Kapadia S, Elgharably H, et al. First-in-human implantations of the navigate bioprosthesis in a severely dilated tricuspid annulus and in a failed tricuspid annuloplasty ring. Circ Cardiovasc Interv, 2017, 10(12): e005840.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Research progress on the treatment of isolated tricuspid regurgitation

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