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

TRIGISTRY Investigators; Julien Dreyfus; Fernando Juarez-Casso; Alessandra Sala; Manuel Carnero-Alcazar; Andrea Eixerés-Esteve; Yohann Bohbot; Baptiste Bazire; Michele Flagiello; Elisabeth Riant; Yannick Mbaki; Jacques Tomasi; Thomas Senage; Kenza Rahmouni El Idrissi; Augustin Coisne; Damien Eyharts; Fabien Doguet; Florence Viau; Florian Eggenspieler; Samuel Heuts; Peyman Sardari Nia; Gregor Heitzinger; Xavier Galloo; Nina Ajmone Marsan; Giovanni Benfari; Luigi Badano; Denisa Muraru; Francesco Maisano; Yan Topilsky; Hector Michelena; Maurice Enriquez-Sarano; Jeroen Bax; Philipp Bartko; Christine Selton-Suty; Gilbert Habib; Yoan Lavie-Badie; Thomas Modine; Vincent Chan; Thierry Le Tourneau; Erwan Donal; Pascal Lim; Costin Radu; Jordan Bernick; George A Wells; Christophe Tribouilloy; Bernard Iung; Jean-François Obadia; Michele De Bonis; Juan Crestanello; David Messika-Zeitoun

doi:10.1093/eurheartj/ehae578

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

TRIGISTRY Investigators
, Julien Dreyfus
, Fernando Juarez-Casso
, Alessandra Sala
, Manuel Carnero-Alcazar
, Andrea Eixerés-Esteve
, Yohann Bohbot
, Baptiste Bazire
, Michele Flagiello
, Elisabeth Riant
, Yannick Mbaki
, Jacques Tomasi
, Thomas Senage
, Kenza Rahmouni El Idrissi
, Augustin Coisne
, Damien Eyharts
, Fabien Doguet
, Florence Viau
, Florian Eggenspieler
, Samuel Heuts

Peyman Sardari Nia, Gregor Heitzinger, Xavier Galloo, Nina Ajmone Marsan, Giovanni Benfari, Luigi Badano, Denisa Muraru, Francesco Maisano, Yan Topilsky, Hector Michelena, Maurice Enriquez-Sarano, Jeroen Bax, Philipp Bartko, Christine Selton-Suty, Gilbert Habib, Yoan Lavie-Badie, Thomas Modine, Vincent Chan, Thierry Le Tourneau, Erwan Donal, Pascal Lim, Costin Radu, Jordan Bernick, George A Wells, Christophe Tribouilloy, Bernard Iung, Jean-François Obadia, Michele De Bonis, Juan Crestanello, David Messika-Zeitoun

Research output: Contribution to journal › Article › peer-review

44 Citations (Scopus)

Abstract

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.

Original language	English
Pages (from-to)	4512-4522
Number of pages	11
Journal	European Heart Journal
Volume	45
Issue number	42
DOIs	https://doi.org/10.1093/eurheartj/ehae578
Publication status	Published - 7 Nov 2024

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© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

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TRIGISTRY Investigators, Dreyfus, J., Juarez-Casso, F., Sala, A., Carnero-Alcazar, M., Eixerés-Esteve, A., Bohbot, Y., Bazire, B., Flagiello, M., Riant, E., Mbaki, Y., Tomasi, J., Senage, T., Rahmouni El Idrissi, K., Coisne, A., Eyharts, D., Doguet, F., Viau, F., Eggenspieler, F., ... Messika-Zeitoun, D. (2024). Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE. European Heart Journal, 45(42), 4512-4522. https://doi.org/10.1093/eurheartj/ehae578

@article{3b7766432ec746c99f64c2a89b2da41c,

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

abstract = "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.",

author = "\{TRIGISTRY Investigators\} and Julien Dreyfus and Fernando Juarez-Casso and Alessandra Sala and Manuel Carnero-Alcazar and Andrea Eixer{\'e}s-Esteve and Yohann Bohbot and Baptiste Bazire and Michele Flagiello and Elisabeth Riant and Yannick Mbaki and Jacques Tomasi and Thomas Senage and \{Rahmouni El Idrissi\}, Kenza and Augustin Coisne and Damien Eyharts and Fabien Doguet and Florence Viau and Florian Eggenspieler and Samuel Heuts and \{Sardari Nia\}, Peyman and Gregor Heitzinger and Xavier Galloo and \{Ajmone Marsan\}, Nina and Giovanni Benfari and Luigi Badano and Denisa Muraru and Francesco Maisano and Yan Topilsky and Hector Michelena and Maurice Enriquez-Sarano and Jeroen Bax and Philipp Bartko and Christine Selton-Suty and Gilbert Habib and Yoan Lavie-Badie and Thomas Modine and Vincent Chan and \{Le Tourneau\}, Thierry and Erwan Donal and Pascal Lim and Costin Radu and Jordan Bernick and Wells, \{George A\} and Christophe Tribouilloy and Bernard Iung and Jean-Fran{\c c}ois Obadia and \{De Bonis\}, Michele and Juan Crestanello and David Messika-Zeitoun",

note = "{\textcopyright} The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].",

year = "2024",

month = nov,

day = "7",

doi = "10.1093/eurheartj/ehae578",

language = "English",

volume = "45",

pages = "4512--4522",

journal = "European Heart Journal",

issn = "0195-668X",

publisher = "Oxford University Press",

number = "42",

}

TRIGISTRY Investigators, Dreyfus, J, Juarez-Casso, F, Sala, A, Carnero-Alcazar, M, Eixerés-Esteve, A, Bohbot, Y, Bazire, B, Flagiello, M, Riant, E, Mbaki, Y, Tomasi, J, Senage, T, Rahmouni El Idrissi, K, Coisne, A, Eyharts, D, Doguet, F, Viau, F, Eggenspieler, F, Heuts, S, Sardari Nia, P, Heitzinger, G, Galloo, X, Ajmone Marsan, N, Benfari, G, Badano, L, Muraru, D, Maisano, F, Topilsky, Y, Michelena, H, Enriquez-Sarano, M, Bax, J, Bartko, P, Selton-Suty, C, Habib, G, Lavie-Badie, Y, Modine, T, Chan, V, Le Tourneau, T, Donal, E, Lim, P, Radu, C, Bernick, J, Wells, GA, Tribouilloy, C, Iung, B, Obadia, J-F, De Bonis, M, Crestanello, J & Messika-Zeitoun, D 2024, 'Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE', European Heart Journal, vol. 45, no. 42, pp. 4512-4522. https://doi.org/10.1093/eurheartj/ehae578

TY - JOUR

T1 - Benefit of isolated surgical valve repair or replacement for functional tricuspid regurgitation and long-term outcomes stratified by the TRI-SCORE

AU - TRIGISTRY Investigators

AU - Dreyfus, Julien

AU - Juarez-Casso, Fernando

AU - Sala, Alessandra

AU - Carnero-Alcazar, Manuel

AU - Eixerés-Esteve, Andrea

AU - Bohbot, Yohann

AU - Bazire, Baptiste

AU - Flagiello, Michele

AU - Riant, Elisabeth

AU - Mbaki, Yannick

AU - Tomasi, Jacques

AU - Senage, Thomas

AU - Rahmouni El Idrissi, Kenza

AU - Coisne, Augustin

AU - Eyharts, Damien

AU - Doguet, Fabien

AU - Viau, Florence

AU - Eggenspieler, Florian

AU - Heuts, Samuel

AU - Sardari Nia, Peyman

AU - Heitzinger, Gregor

AU - Galloo, Xavier

AU - Ajmone Marsan, Nina

AU - Benfari, Giovanni

AU - Badano, Luigi

AU - Muraru, Denisa

AU - Maisano, Francesco

AU - Topilsky, Yan

AU - Michelena, Hector

AU - Enriquez-Sarano, Maurice

AU - Bax, Jeroen

AU - Bartko, Philipp

AU - Selton-Suty, Christine

AU - Habib, Gilbert

AU - Lavie-Badie, Yoan

AU - Modine, Thomas

AU - Chan, Vincent

AU - Le Tourneau, Thierry

AU - Donal, Erwan

AU - Lim, Pascal

AU - Radu, Costin

AU - Bernick, Jordan

AU - Wells, George A

AU - Tribouilloy, Christophe

AU - Iung, Bernard

AU - Obadia, Jean-François

AU - De Bonis, Michele

AU - Crestanello, Juan

AU - Messika-Zeitoun, David

N1 - © The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact [email protected] for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [email protected].

PY - 2024/11/7

Y1 - 2024/11/7

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/85208772160

U2 - 10.1093/eurheartj/ehae578

DO - 10.1093/eurheartj/ehae578

M3 - Article

C2 - 39212387

SN - 0195-668X

VL - 45

SP - 4512

EP - 4522

JO - European Heart Journal

JF - European Heart Journal

IS - 42

ER -

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

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