Secondary tricuspid regurgitation in advanced heart failure: still more questions than answers?

Abstract

Historically, it has long been considered that neither the right ventricle nor the tricuspid valve is essential when correctly functioning left heart and pulmonary artery hemodynamics exist. This perspective developed from extensive follow-up of patients undergoing the Fontan operation or those with congenital/iatrogenic tricuspid valve atresia. For instance, long-term survival rates for Fontan patients at the Mayo Clinic were observed to be 74, 61 and 43% over 10, 20 and 30 years, respectively. However, with advancements in surgical techniques, the survival rate at 10 years for surgeries performed after 2001 soared to 95%. 1 Moreover, choosing tricuspid valvectomy over valve replacement remains a viable option for treating infective endocarditis, with no significant differences in short-term to medium-term outcomes; 2,3 even more, a recently published case report described a 30-year-long evolution until debilitating heart failure (HF) occurrence in a patient having had tricuspid valvectomy for intravenous drugs-related endocarditis. 4