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Meta-Analysis
. 2025 Mar 12;12(1):e002986.
doi: 10.1136/openhrt-2024-002986.

Survival outcomes in isolated severe tricuspid regurgitation according to therapeutic modalities: a systematic review and meta-analysis

Gaspard Suc #  1   2   3 , Jules Mesnier #  4   2   3 , Audrey Cailliau  4   2   3 , Mustafa Habib  4   2   3 , Clemence Delhomme  4   2   3 , Dimitri Arangalage  4   2   3 , Dominique Himbert  4   2   3 , Gregory Ducrocq  4   2   3 , Eric Brochet  4   2   3 , Alec Vahanian  4   2   3 , Bernard Iung  4   2   3 , Marina Urena-Alcazar  4   2   3
Affiliations
Meta-Analysis

Survival outcomes in isolated severe tricuspid regurgitation according to therapeutic modalities: a systematic review and meta-analysis

Gaspard Suc et al. Open Heart. .

Abstract

Importance: Managing isolated severe tricuspid regurgitation (TR) poses significant challenges, with questions recently arising about the efficacy of surgery and percutaneous therapies compared with conservative approaches in improving survival.

Objective: We aimed to assess the available evidence on mortality associated with different treatment modalities for isolated severe TR.

Evidence review: A comprehensive search of medical databases was conducted. Studies reporting mortality of isolated TR at 1-year follow-up, with TR severity classified as moderate-to-severe or worse, were included. Exclusion criteria were TR associated with left-heart disease and combined procedures (treating other valves). The primary endpoint was all-cause mortality at 1 year, with secondary outcomes including in-hospital, 2-year and 5-year mortality. Mortality was compared by meta-analysis and meta-regression using age, sex and left ventricular ejection fraction as confounders.

Findings: 25 studies met the inclusion criteria. Mean age was 72.0 years among the 5702 patients managed medically, 71.3 years among the 1416 patients treated percutaneously and 59.3 years among the 1990 patients managed surgically. In medically managed patients, 1-year, 2-year and 5-year mortality rates were 14%, 20% and 46%, respectively. Among percutaneously managed patients, there was an in-hospital mortality of 1% and a 1-year mortality rate of 18%, which increased to 22% at 2 years. Surgically managed patients experienced an in-hospital mortality of 8% with 1-year, 2-year and 5-year mortality rates of 15%, 20% and 30%, respectively. No statistical differences in mortality were observed at 1, 2 or 5 years. Those results were confirmed after adjusted meta-regression.

Conclusions: These findings underscore the significant long-term mortality associated with isolated severe TR, regardless of treatment group. Despite potential selection bias, both percutaneous and surgical interventions did not offer lower mortality rates compared with medical management after 2 years. Further research is warranted to improve outcomes in the management of isolated TR.

Keywords: Heart Valve Prosthesis Implantation; Meta-Analysis; Tricuspid Valve Insufficiency.

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Conflict of interest statement

Competing interests: DH received protocol funding for ABBOT Vascular and Edwards Lifesciences, EB received proctoring funds from ABBOTT vascular. MU-A received speaker fees from Edwards Lifesciences. GD received speaker fees from Abbott, Amarin, Amgen, Astra Zeneca, Boston scientific, BMS, Novo Nordisk and Sanofi, proctoring fees from Boston scientific and steering committee from Agmen, Novo Nordisk and Janssen, and ownership interest from Bioquantis. The other authors have no disclosure.

Figures

Figure 1
Figure 1. Flow chart. *Consider, if feasible to do so, reporting the number of records identified from each database or register searched (rather than the total number across all databases/registers). **If automation tools were used, indicate how many records were excluded by a human and how many were excluded by automation tools. Source: Page et al. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; TR, tricuspid regurgitation.
Figure 2
Figure 2. Kaplan-Meier curves of mortality according to treatment group.
Figure 3
Figure 3. Mortality rates at 1 year in the medical therapy, surgery and percutaneous therapy group.
Figure 4
Figure 4. Mortality rates at 2 years in the medical therapy, surgery and percutaneous therapy group.
Figure 5
Figure 5. Mortality rates at 5 years in the medical therapy and surgery group.
See this image and copyright information in PMC

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