Commentary: Tricuspid valve disease at the time of surgical aortic valve replacement: Treat it or leave it?

Central MessageThis retrospective analysis of the STS database sought to determine evidence for a more aggressive operative strategy concomitant tricuspid valve disease at time aortic replacement.See Article page 44. This replacement. See Current recommendations from guidelines American Heart Association/American College Cardiology and European Society Cardiology/European Association Cardiothoracic Surgery reflect limited well-controlled trials supporting early surgical treatment functional regurgitation (TR).1Nishimura R.A. Otto C.M. Bonow R.O. Carabello B.A. Erwin III, J.P. Fleisher L.A. et al.2017 AHA/ACC focused update 2014 guideline management patients with valvular heart disease: report Cardiology/American task force on clinical practice guidelines.J Am Coll Cardiol. 2014; 63: 2438-2488Crossref PubMed Scopus (1308) Google Scholar,2Baumgartner H. Falk V. Bax J.J. De Bonis M. Hamm C. Holm P.J. ESC/EACTS disease.Eur J. 2017; 38: 2739-2791Crossref (2) Scholar Accumulating data recent observational studies almost uniformly underscore adverse prognosis relevant TR even show that often persists or progresses after successful correction mitral disease, including transcatheter replacement.3Antunes M.J. Rodríguez-Palomares Prendergast B. Rosenhek R. Al-Attar N. al.ESC Working Groups Cardiovascular Valvular DiseaseManagement regurgitation: position statement working groups cardiovascular surgery J Cardiothorac Surg. 52: 1022-1030Crossref Scholar, 4Jeong D.S. Sung K. Kim W.S. Lee Y.T. Yang J.H. Jun T.G. al.Fate in stenosis replacement.J Thorac Cardiovasc 148: 1328-1333.e1Abstract Full Text PDF (40) 5Shamekhi Sugiura A. Tabata Al-Kassou Weber Sedaghat al.Impact undergoing replacement.JACC Interv. January 9, 2020; ([Epub ahead print])Crossref (4) Indeed, moderate severe was found be linked substantial increase mortality than 20,000 cardiac over 24-year follow-up period.6Kelly B.J. Ho Luxford J.M. Butler C.G. Huang C.C. Wilusz Ejiofor J.I. al.Severity is associated long-term mortality.J 2018; 155: 1032-1038Abstract (17) These findings have fired controversial discussion among experts, some support liberal indication (TVS) left-sided surgery. The term “left-sided” includes 2 different pathophysiologic entities TR, being most common. An Thoracic Surgeons (STS) database, which included 50,000 TVS between 2000 2010, demonstrated 86% procedures were performed surgery.7Kilic Saha-Chaudhuri P. Rankin J.S. Conte J.V. Trends outcomes North America: an database.Ann 2013; 96: 1546-1552Abstract (165) common procedure approximately 79% all cases, whereas replacement (AVR) alone less 10% patients. Consequently, current recommendation are largely based patient cohorts it unclear whether presence should addressed similar way.3Antunes Scholar,6Kelly Scholar,7Kilic In this issue Journal, Chancellor co-workers8Chancellor W.Z. Mehaffey Beller Hawkins R.B. Speir A.M. Quader M.A. without repair during 2021; 162: 44-50.e2Abstract regional 17,000 who underwent AVR 19 centers 2001 2017.8Chancellor Forty-one percent had mild AVR, incidence 6% 1%, respectively. Only 0.6% TVS, predominantly (31%) As expected previous reports,6Kelly increasing severity 2-fold 4-fold higher when compared TR. Surgical significantly increased morbidity isolated (15% vs 4%), independently Finally, adjustment confounding variables, such as coronary artery bypass grafting, resulted comparable outcomes, did reach statistical difference propensity score matching. Several important aspects limitations considered interpreting results presented by coworkers.8Chancellor contrast reports form especially strongly underused cohort. Although authors can only speculate about exact reasons observation together design study does not allow conclusive interpretation their outcome best addition, attempt adjust matching 55 matched pairs, sample size clearly underpowered robust results. Furthermore, preoperative variables etiology right ventricular function, pulmonary hypertension, annular dimension before surgery, residual correction, obtained. aforementioned well acknowledged within do reduce importance present work. Instead, congratulated focusing topic up now has received adequate attention community. Further will needed evaluate benefits AVR. Impact replacementThe Journal SurgeryVol. 162Issue 1PreviewLong-term worse (TR), but impact intervention remains unclear. purpose effect Full-Text