Tricuspid Regurgitation Dilemma: A Comparison Study between Surgical Versus Medical Management of Patients with Tricuspid Regurgitation

The management of the medical and surgical treatment of tricuspid regurgitation (TR) is still controversial because of the contradictory outcomes of relevant studies. The present study sought to compare these 2 management modalities in terms of survival rates and predictors of clinical outcomes.
The present 7-year retrospective cohort study, conducted in 2014 at a tertiary center, recruited 806 consecutive patients with TR. The study population was divided into surgically and medically treated patients. After matching the 2 groups, we analyzed 686 patients (399 [58.2%] patients in the surgical treatment group), consisting of 216 (31.5%) male and 470 (68.5%) female patients at a mean age of 53.0 ± 13.4 years. There were 319 (49.5%) patients with severe TR (216 [67.7%] patients in the surgical treatment group).
In the patients with severe TR in the New York heart association (NYHA) functional classes (FCs) of III and IV, the 5-year survival rate was 78.6% in the surgical treatment group and 60.6% in the medical treatment group. The Cox regression analysis showed that age, preoperative NYHA FC, inferior vena cava (IVC) size, length of admission, ICU stay days, and postoperative complications in the surgical treatment group and symptoms (chest pain, ascites, and peripheral edema), number of rehospitalization and IVC size in the medical treatment group were the significant independent risk factors of mortality.
Overall mortality in the patients with severe TR had a significant correlation with the patients’ NYHA FC symptoms (ascites, peripheral edema, and chest pain), and IVC size. The survival rates of the patients with severe TR in the NYHA FCs of III and IV were higher in the surgery group and were affected by several preoperative and operative factors.