Natural history and clinical outcomes of de novo functional tricuspid regurgitation after the Ross procedure.

Authors

Arman Sarshoghi, Nabil Ajmi, Pierre-Emmanuel Noly, Nancy Poirier, Pierre-Luc Bernier, Ismail El-Hamamsy, Ismail Bouhout, Philippe Demers

Published in

JTCVS open. Volume 32. Pages 101836. Epub May 04, 2026.

Abstract

To characterize the natural history, predictors, and clinical outcomes of de novo severe functional tricuspid regurgitation (TR) following the Ross procedure.
At a single institution, 699 consecutive adults without preoperative severe TR undergoing the Ross procedure between 2011 and 2025 were reviewed. De novo severe TR was defined as TR grade ≥3 within 6 months postoperatively. Propensity score overlap weighting was used to balance 21 covariates between patients who developed de novo severe TR and those who did not. Weighted generalized estimating equations were used to analyze longitudinal TR trajectories. Predictors were identified using LASSO regression. Survival and reintervention were compared using weighted Kaplan-Meier and Aalen-Johansen methods.
De novo severe TR occurred in 61 patients (8.7%), appearing at a median of 5 days postoperatively. The groups demonstrated significantly different TR trajectories (P for interaction <.001), with rapid spontaneous improvement in the de novo severe TR group. TR severity decreased to less than severe in 49 of the 61 patients (80.3%) in 2 years. Independent predictors of de novo severe TR included female sex (odds ratio [OR], 4.79; 95% confidence interval [CI], 1.99-11.56), diabetes (OR, 2.53; 95% CI, 1.09-5.88), and preoperative TR grade per unit increment (OR, 2.30; 95% CI, 1.26-4.20). At 10 years, freedom from death was 100% in the TR group versus 93.4% in the control group (P = .26), and cumulative reintervention on any valve was 3.0% versus 5.3% (P = .62).
De novo severe TR after the Ross procedure is common but transient, resolving spontaneously without any adverse impact on survival or need for reintervention. These findings support a conservative management strategy with echocardiographic surveillance.

PMID:
42604346
Bibliographic data and abstract were imported from PubMed on 16 Aug 2026.

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