• functional tricuspid regurgitation
• isolated tricuspid valve surgery
• primary tricuspid regurgitation

Tricuspid valve regurgitation (TVR) is mistakenly considered almost benign compared to left-side valvular conditions, but it is associated with long-term adverse outcome independent of right ventricle (RV) failure and of pulmonary hypertension. Isolated tricuspid valve surgery is a rare occurrence and has one of the worst outcomes among valve procedures.
This is a retrospective single center study on acquired TVR undergoing isolated TV surgery at Ospedale del Cuore G. Pasquinucci in Massa between 1998 and 2018. We collected data from 41 consecutive patients. Mean age was 56 ±15 years, 85% of the patients had severe TVR and 49% of them had already been subjected to previous cardiac surgery in the past, predominantly on the mitral valve. The most common cause of TVR among our patients was endocarditis (37%), followed by functional TVR (24%) and degenerative TVR (15%).
Median follow-up duration was 48 months. Survival from cardiac death at 8 years follow-up was 85%. Freedom from cardiac events (MAVRE, rehospitalization for heart failure and cardiac death) at 8 years follow-up was 50%.
Isolated TV surgery is commonly considered a high-risk procedure, and while mean preoperative risk scores were elevated (Logistic EUROscore 10,5%, EUROscore II 7,8% and CRS mortality 6,5%), observed in-hospital mortality in our population was only 2%.
Among preoperative characteristics, we found a correlation with 30 days adverse outcomes for Model for End Stage Liver Disease score (OR 1.28, 95% CI 1.01-1.63; p-value 0.048) and for a NYHA class ≥3 (OR 14.00; 95% CI 1.02-192, p-value 0.049). These data are consistent with the emerging idea that accurate patient selection and early referral are vital in order to improve isolated TV surgery results. Patients that undergo surgery at a late-stage disease bear the consequences of a long history of TVR, such as RV dysfunction and overall impaired cardiac performance, and systemic repercussions of venous hypertension (i.e. congestive hepatic failure), while an earlier referral would lead to better surgical outcomes.