Management and prognosis of tricuspid regurgitation
- Catherine M Otto, MD
Catherine M Otto, MD
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Cardiac Evaluation
- Section Editor — Valvular Disease
- Professor of Medicine
- University of Washington
Tricuspid regurgitation (TR) is a relatively common abnormality. Since this lesion is frequently asymptomatic and may not be detected on physical examination, it is often diagnosed solely by echocardiography. This topic will review the prognosis and management of TR.
Etiology, clinical features, and evaluation of TR are discussed separately. (See "Etiology, clinical features, and evaluation of tricuspid regurgitation".)
While the clinical setting (particularly concomitant cardiovascular disease) influences survival in patients with tricuspid regurgitation (TR), severe TR is an independent predictor of mortality, as illustrated by the following studies:
●In a study of 5223 patients (mean age 67 years) at three Veterans Affairs medical centers, one-year survival rates were 92, 90, 79, and 64 percent in patient groups with no, mild, moderate, or severe TR, respectively . The causes of TR were not specified. Moderate or greater TR was associated with increased mortality regardless of pulmonary artery systolic pressure or left ventricular ejection fraction (LVEF). Severe TR, age, LVEF, inferior vena cava dilation, and moderate or greater right ventricular (RV) enlargement were associated with impaired survival.
●In a study of 1421 patients with an LVEF ≤35 percent, 34 percent had moderate to severe TR . Severe TR was an independent predictor of mortality along with severe mitral regurgitation, cancer, coronary artery disease, heart rate, and LVEF.
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- APPROACH TO MANAGEMENT
- MEDICAL MANAGEMENT
- Treatment of heart failure
- Treatment of causes of pulmonary hypertension
- Physical activity and exercise
- TRICUSPID VALVE SURGERY
- - At the time of left-sided valve surgery
- - For isolated tricuspid valve surgery
- - At the time of pericardiectomy
- Repair versus replacement
- - Valve repair
- - Valve replacement
- Timing and risk stratification
- Management of leads
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS