Introduction
Interest in tricuspid valve (TV) pathology has recently grown, due to
reported poor clinical outcome of patients affected by tricuspid
regurgitation (TR) and the impact on long-term survival of such
pathology1–3. In particular, isolated TR has been
traditionally managed with medical therapy for a long time before
referring patients to surgery. Indeed earlier referral has been
discouraged by the poor results of tricuspid repair or replacement whose
hospital mortality has remained stable around 10%4–7over the years. The current European8 and
American9 Guidelines for the management of valvular
disease provide somehow different recommendations for isolated tricuspid
surgery. The American guidelines tend to be more conservative and
suggest waiting for signs or symptoms of “right heart failure” before
recommending tricuspid repair (TVr) or replacement (TVR) (class IIa or
IIb depending on the etiology). In asymptomatic patients with primary
severe isolated TR and progressive RV dilation/dysfunction only a class
IIb recommendation is given. Unfortunately, in severe isolated TR,
“persisting symptoms” usually develop only in advanced stages of the
disease being mainly the clinical manifestation of right ventricular
failure, with organ damage and hepato-renal
syndrome10. These patients face high morbidity and
mortality after surgery, further fuelling the belief of TV surgery being
a high-risk procedure. On the other hand, European Guidelines strongly
support an earlier surgical referral, even in asymptomatic patients,
with initial RV dilation/dysfunction to achieve low hospital mortality
and better postoperative outcome8. Indeed, the
surgical act of tricuspid repair or replacement is not technically
demanding in itself and the outcome is therefore almost exclusively
depending on the baseline patient’s profile. The absence of a validated
risk score for such surgical procedures, poses further uncertainty
regarding the best management of these patients and the correct timing
of intervention11–14. A better understanding of the
baseline characteristics of patients who experience a regular versus a
non-regular postoperative course can help the decision-making regarding
the surgical timing of those challenging cases.
The aim of this study was to better define the profile of patients who
had a smooth versus a complicated postoperative course following
isolated tricuspid valve surgery, in order to try to identify predictors
of a favourable or unfavourable in-hospital outcome.