Evaluation Results and Recommendations of a Novel Tricuspid Regurgitation Classification for Isolated Tricuspid Valve Replacement Surgery

Background: There are still no accepted classification and recommendations for isolated tricuspid valve replacement (ITVR) surgery. So we aim to evaluate the applicability of the tricuspid valve regurgitation classification proposed by Latib in 2018 for ITVR surgery. Methods: We enrolled all patients who underwent ITVR from 2000 to 2021 in our center. Based on a novel classification, the patients were divided into five stages, and in-hospital mortality was used as the primary endpoint to analyze whether this classification scheme was a good way to evaluate the prognosis of patients at different stages and with different surgical options. Results: A total of 254 patients who underwent ITVR were divided into five stages. None of the patients was classified into stage 1, and stages 4/5 accounted for 159 (62.6%). There was no difference in age, gender, or body mass index (BMI). 178 (70.1%) patients underwent traditional open surgery and 76 (29.9%) opted for the transcatheter option. The main etiology was functional tricuspid regurgitation (FTR), with 64.9% of these patients in stage 4 or above. The overall in-hospital mortality rate was 14.2%, with 14.0% in stage 4 vs. 37.8% in stage 5 (p < 0.001). The patients in the intervention group were generally older, and coronary heart disease and atrial fibrillation were also more common (p < 0.05). Interventional mortality for stages 4 and 5 was 35.8% vs. 13.2% in the open group, but there was no significant difference between them after propensity score matching. Conclusions: The tricuspid regurgitation's (TR's) five-stage classifications can predict prognosis for different patients. After this classification, no difference was found between the two procedures, and open surgery is recommended for patients with acceptable general conditions.