Prognosis

Mild to moderate (asymptomatic) tricuspid stenosis

In the absence of progression to severe disease, prognosis is good. Isolated mild to moderate tricuspid stenosis (TS) is well tolerated and rarely requires intervention. Progression to severe TS is common in patients with carcinoid heart disease if the malignancy is not treated. The frequency of progression to severe TS in rheumatic valve disease is variable. Regardless of the aetiology, a follow-up visit with a cardiologist is recommended annually.

Severe (symptomatic) tricuspid stenosis

Once symptoms occur, medical therapy is instituted and valve intervention is considered. For most, surgery (valve repair or replacement) will be the most likely treatment option offered. Peri-operative mortality related to valve repair and replacement continues to be relatively high in the carcinoid group despite significant improvements in surgical and anaesthetic techniques. Studies have demonstrated peri-operative mortality ranging from 9% to 20%.[60][61] Right ventricular dilatation, systolic dysfunction, and advanced New York Heart Association (NYHA) class have been implicated in those who suffered poor peri-operative outcomes. Peri-operative mortality with valve replacement in patients with TS secondary to other causes is much lower, which is likely to be due to a decreased incidence of co-existing tricuspid regurgitation and right ventricular dilatation.

Following successful tricuspid valve repair or replacement, symptoms of right heart failure will generally subside within 6 months and the overall prognosis for these patients is very good. Heart failure is the predominant cause of early and late deaths, emphasising the importance of timely referral before the development of end-stage cardiac disease.[40]

Long-term survival for tricuspid valve replacement in carcinoid heart disease has been reported to be as high as 100% at median follow-up of 37 months.[61] Other studies reporting results of valve replacement for various acquired heart conditions have shown only modest results with 50% survival at 10 and 15 years.[40][45][60][61]

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