Citations 2
Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE
Dreyfus, Julien , Juarez-Casso, Fernando M. , Eixerés‐Esteve, Andrea , Bohbot, Yohann, Bazire, Baptiste , Flagiello, Michele , Riant, Elisabeth , Mbaki, Yannick, Tomasi, Jacques , Sénage, Thomas , Eyharts, Damien , Doguet, Fabien , Viau, F , Eggenspieler, Florian , Heuts, Samuel , Galloo, Xavier , Benfari, Giovanni , Badano, Luigi P. , Enriquez-Sarano, Maurice, Bartko, Philipp E. , Lim, Pascal , Radu, Costin , Bernick, Jordan , Wells, George A. , Tribouilloy, Christophe , Iung, Bernard , Bonis, Michele De , Juarez-Casso, Fernando, Bazire, Baptiste , Flagiello, Michele , Riant, Elisabeth , Tomasi, Jacques , Senage, Thomas , Eyharts, Damien , Doguet, Fabien , Viau, Florence , Heuts, Samuel , Sardari Nia, Peyman , Heitzinger, Gregor , Marsan, Nina Ajmone , Maisano, Francesco , Topilsky, Yan , Michelena, Hector, Selton-Suty, Christine , Habib, Gilbert , Lavie-Badie, Yoan , Modine, Thomas , Chan, Vincent , Donal, Erwan , Wells, George , Tribouilloy, Christophe , De Bonis, Michele , Messika-Zeitoun, David , Enriquez-Sarano, Maurice , Benfari, Giovanni , Sala, Alessandra , Carnero, Manuel , Rahmouni, Kenza , Coisne, Augustin , Heitzinger, Gregor , Marsan, Nina Ajmone , Muraru, Denisa , Maisano, Francesco , Topilsky, Yan , Michelena, Héctor I. , Enriquez‐Sarano, Maurice , Bax, Jeroen J. , Selton‐Suty, Christine , Habib, Gilbert , Modine, Thomas , Chan, Vincent , Tourneau, Thierry Le , Donal, Erwan , Obadia, Jean‐François , Crestanello, Juan A. , Messika–Zeitoun, David
European Heart Journal | August 19, 2024 | Volume: 45 | Issue: 42 | Pages: 4512-4522
Abstract Background and Aims 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. Methods 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). Results 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). Conclusions 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.
TRI-SCORE and benefit of intervention in patients with severe tricuspid regurgitation
Dreyfus, Julien , Galloo, Xavier , Heitzinger, Gregor , Benfari, Giovanni , Kresoja, Karl-Patrick, Juarez-Casso, Fernando M. , Omran, Hazem , Russo, Giulio , Topilsky, Yan , Weber, Marcel, Sala, Alessandra , Eixerés‐Esteve, Andrea , Riant, Elisabeth , Donal, Erwan , Hausleiter, Jörg , Badano, Luigi P. , Coisne, Augustin , Windecker, Stephan , Zamorano, José Luis , Tang, Gilbert H L, Webb, John G. , Muraru, Denisa , Nejjari, Mohammed , Bonis, Michele De , Carnero, Manuel , Nickenig, Georg, Pfister, Roman , Tribouilloy, Christophe , Rudolph, Volker , Lurz, Philipp , Bartko, Philipp E. , Messika–Zeitoun, David , investigators, TRIGISTRY, Heitzinger, Gregor, Bohbot, Yohan, Topilsky, Yan , Weber, Marcel, Lim, Pascal , Bazire, Baptiste , Donal, Erwan, Tourneau, Thierry Le, Modine, Thomas, Doguet, Fabien , Ajmone-Marsan, N, Stolz, Lukas, Praz, Fabien, Zamorano, José Luís , Bardeleben, Ralph Stephan von, Tang, Gilbert H L, Lubos, Edith, Webb, John A., Schöfer, Joachim, Fam, Neil , Lauten, Alexander , Pedrazzini, Giovanni , Rodés‐Cabau, Josep , Gavazzoni, Mara , Flagiello, Michele, Radu, Costin , Mbaki, Yannick, Tomasi, Jacques , Sénage, Thomas , Chan, Vincent, Alessandrini, Hannes , Eyharts, Damien , Viau, F , Himbert, Dominique , Sievert, Horst, Eggenspieler, Florian , Nicol, Martin , Nickenig, Georg , Pfister, Romain, Crestanello, Juan, Maisano, Francesco, Messika-Zeitoun, David, Kresoja, Karl-Patrik , Heitzinger, Gregor , Juarez-Casso, Fernando, Omran, Hazem , Russo, Giulio , Topilsky, Yan , Nombela-Franco, Luis , Riant, Elisabeth , Donal, Erwan , Hausleiter, Jörg , Coisne, Augustin , Praz, Fabien , Windecker, Stephan , Nejjari, Mohammed , Chan, Vincent , De Bonis, Michele , Carnero-Alcazar, Manuel , Pfister, Roman , Tribouilloy, Christophe , Rudolph, Volker , Lurz, Philipp , Maisano, Francesco , Messika-Zeitoun, David , Enriquez-Sarano, Maurice , Benfari, Giovanni , Kresoja, Karl-Patrik , Taramasso, Maurizio , Bohbot, Yohann , Iliadis, Christos , Weber, Marcel , Nombela‐Franco, Luis , Iung, Bernard , Obadia, Jean‐François , Estévez‐Loureiro, Rodrigo , Tourneau, Thierry Le , Modine, Thomas , Latib, Azeem , Praz, Fabien , von Bardeleben, Ralph Stephan , Tang, Gilbert H L, Hahn, Rebecca T , Chan, Vincent , Crestanello, Juan A. , Maisano, Francesco , Bax, Jeroen J. , Enriquez‐Sarano, Maurice , investigators, TRIGISTRY, Heitzinger, Gregor, Weber, Marcel, Donal, Erwan, Tourneau, Thierry Le, Modine, Thomas, Lavie-Badie, Yoan , Habib, Gilbert , Selton‐Suty, Christine , Stolz, Lukas , Praz, Fabien, Bardeleben, Ralph Stephan von, Ruf, Tobias Friedrich , Tang, Gilbert H L, Webb, John, Michelena, Héctor I. , Solı́s, Jorge , Flagiello, Michele, Chan, Vincent, Rahmouni, Kenza , Viau, Florence, Pfister, R, Crestanello, Juan, Maisano, Francesco, Messika-Zeitoun, David
European Heart Journal | August 24, 2023 | Volume: 45 | Issue: 8 | Pages: 586-597
Abstract Background and aims Benefit of tricuspid regurgitation (TR) correction and timing of intervention are unclear. This study aimed to compare survival rates after surgical or transcatheter intervention to conservative management according to a TR clinical stage as assessed using the TRI-SCORE. Methods A total of 2,413 patients with severe isolated functional TR were enrolled in TRIGISTRY (1217 conservatively managed, 551 isolated tricuspid valve surgery, and 645 transcatheter valve repair). The primary endpoint was survival at 2 years. Results The TRI-SCORE was low (≤3) in 32%, intermediate (4–5) in 33%, and high (≥6) in 35%. A successful correction was achieved in 97% and 65% of patients in the surgical and transcatheter groups, respectively. Survival rates decreased with the TRI-SCORE in the three treatment groups (all P < .0001). In the low TRI-SCORE category, survival rates were higher in the surgical and transcatheter groups than in the conservative management group (93%, 87%, and 79%, respectively, P = .0002). In the intermediate category, no significant difference between groups was observed overall (80%, 71%, and 71%, respectively, P = .13) but benefit of the intervention became significant when the analysis was restricted to patients with successful correction (80%, 81%, and 71%, respectively, P = .009). In the high TRI-SCORE category, survival was not different to conservative management in the surgical and successful repair group (61% and 68% vs 58%, P = .26 and P = .18 respectively). Conclusions Survival progressively decreased with the TRI-SCORE irrespective of treatment modality. Compared to conservative management, an early and successful surgical or transcatheter intervention improved 2-year survival in patients at low and, to a lower extent, intermediate TRI-SCORE, while no benefit was observed in the high TRI-SCORE category.