Tricuspid regurgitation: Frequency, management and outcome among patients with severe left-sided valvular heart disease in Europe. Insights from the ESC-EORP Valvular Heart Disease II survey

Tricuspid regurgitation (TR) is frequent among patients with severe left-sided valvular heart disease (VHD). This study sought to assess TR frequency, management and outcome in this population. Among 6883 patients with severe LS-VHD or previous valvular intervention in the EURObservational Research Programme prospective VHD II survey, we analyzed frequency and grade of TR according to LS-VHD, and 6-month survival according to TR grade. Among 2081 patients who underwent an intervention for severe LS-VHD, we analyzed frequency and outcome of concomitant TV intervention, and concordance between Class I indications for concomitant TV surgery (patients with severe TR) and real-practice decision-making. Moderate to severe TR was frequent among patients with severe mitral VHD (30%), especially with secondary mitral regurgitation (46%), and rare among patients with aortic VHD (< 5%). Higher TR grade was associated with a poorer 6-month survival (P < 0.001). Rates of concomitant tricuspid valve (TV) intervention at the time of left-sided heart valve surgery were high at the time of mitral valve surgery (more than 40%). Concomitant TV intervention at the time of left-sided heart valve surgery (LS-HVS) was not associated with an increase in-hospital mortality (P = 0.93). Concordance between Class I indications for concomitant TV surgery at the time of LS-HVS according to guidelines and real-practice decision-making was very good (88% overall). TR was frequent in patients with mitral VHD and was associated with a poorer outcome as TR grade increased. Adherence to guidelines for Class I indications for concomitant TV surgery at the time of LS-HVS was very good.