Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE - Université de Picardie Jules Verne
Article Dans Une Revue European Heart Journal Année : 2024

Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE

1 CCN - Centre cardiologique du Nord
2 Mayo Clinic [Rochester]
3 IRCCS Ospedale San Raffaele [Milan, Italy]
4 MP3CV - Mécanismes physiopathologiques et conséquences des calcifications cardiovasculaires - UR UPJV 7517
5 Service de Cardiologie [Amiens]
6 AP-HP - Hôpital Bichat - Claude Bernard [Paris]
7 HCL - Hospices Civils de Lyon
8 HEGP - Hôpital Européen Georges Pompidou [APHP]
9 LTSI - Laboratoire Traitement du Signal et de l'Image
10 Centre Hospitalier Universitaire de Rennes [CHU Rennes] = Rennes University Hospital [Pontchaillou]
11 SPHERE - MethodS in Patients-centered outcomes and HEalth ResEarch
12 University of Ottawa Heart Institute
13 RNMCD - Récepteurs Nucléaires, Maladies Métaboliques et Cardiovasculaires - U 1011
14 EGID - Institut Européen de Génomique du Diabète - European Genomic Institute for Diabetes - FR 3508
15 CHU Toulouse - Centre Hospitalier Universitaire de Toulouse
16 EnVI - Endothélium, valvulopathies et insuffisance cardiaque
17 APHM - Assistance Publique - Hôpitaux de Marseille
18 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
19 Maastricht University [Maastricht]
20 MUMC - Maastricht University Medical Centre
21 Medizinische Universität Wien = Medical University of Vienna
22 VUB - Vrije Universiteit Brussel [Bruxelles]
23 LUMC - Leiden University Medical Center
24 UNIVR - Università degli studi di Verona = University of Verona
25 IAI - Istituto Auxologico Italiano IRCCS Ospedale San Luca [Milan, Italy]
26 IRCCS - Istituti di Ricovero e Cura a Carattere Scientifico
27 UNIMIB - Università degli Studi di Milano-Bicocca = University of Milano-Bicocca
28 IRCCS - Istituto di Ricovero e Cura a Carattere Scientifico
29 Sackler Faculty of Medicine
30 Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
31 Service de Cardiologie [CHRU Nancy]
32 TIMONE - Hôpital de la Timone [CHU - APHM]
33 Hôpital Haut-Lévêque [CHU Bordeaux]
34 ITX-lab - ITX-lab unité de recherche de l'institut du thorax UMR1087 UMR6291
35 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
36 IMRB - Institut Mondor de Recherche Biomédicale
37 CHU Henri Mondor [Créteil]
38 LVTS (UMR_S_1148 / U1148) - Laboratoire de Recherche Vasculaire Translationnelle
39 Hôpital Louis Pradel [CHU - HCL]
40 UniSR - Universita Vita Salute San Raffaele = Vita-Salute San Raffaele University [Milan, Italie]
Julien Dreyfus
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Manuel Carnero-Alcazar
  • Fonction : Auteur
Andrea Eixerés-Esteve
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Michele Flagiello
Nina Ajmone Marsan
Yan Topilsky
Gilbert Habib
Thomas Modine
Vincent Chan
George Wells

Résumé

Background and aims: Severe tricuspid regurgitation (TR) 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 surgery. Methods: In TRIGISTRY, an international cohort study of consecutive patients with severe isolated functional TR (33 centers, 10 countries), survival rates up to 10 years were compared between patients who underwent isolated tricuspid valve (TV) surgery (repair or replacement) and those conservatively managed, overall and according to TRI-SCORE category (low: ≤3, intermediate: 4-5, high: ≥6). Results: 1,217 were managed conservatively, and 551 underwent isolated TV surgery (200 repairs, 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] 0.97; 95% confidence interval [CI] 0.88-1.08, P=0.57). Surgery improved survival compared to conservative management in the low TRI-SCORE category (72% vs. 44%; HR 0.27; 95% CI 0.20-0.37, P<0.0001), but not in the intermediate (36% vs. 37%, HR 1.17; 95%CI 0.98-1.40, P=0.09) or high categories (20% vs. 24%; HR 1.06; 95% CI 0.91-1.25, P=0.45). Both repair and replacement improved survival in the low TRI-SCORE category (84% and 61% vs. 44%; HR 0.11; 95% CI 0.06-0.19, P<0.0001, and HR 0.65; 95% CI 0.47-0.90, P=0.009). Repair showed benefit in the intermediate category (59% vs. 37%; HR 0.49; 95% CI 0.35-0.68, P<0.0001) while replacement was possibly harmful (25% vs. 37%; HR 1.43; 95% CI 1.18-1.72, P=0.0002). 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. Trial registration: TRIGISTRY: ClinicalTrials.gov, NCT05825898.
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mardi 18 février 2025
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mardi 18 février 2025
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Année Mois Jours
Avant la publication
mardi 18 février 2025
Fichier sous embargo
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Année Mois Jours
Avant la publication
mardi 18 février 2025
Fichier sous embargo
mardi 18 février 2025
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Dates et versions

hal-04687175 , version 1 (24-10-2024)

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Julien Dreyfus, Fernando Juarez-Casso, Alessandra Sala, Manuel Carnero-Alcazar, Andrea Eixerés-Esteve, et al.. Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE. European Heart Journal, 2024, 45 (42), pp.4512-4522. ⟨10.1093/eurheartj/ehae578⟩. ⟨hal-04687175⟩
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