Adding tricuspid repair to standard open heart surgery does not increase risk but improves right ventricular function

Area of Science:

• Cardiology
• Cardiac Surgery
• Valvular Heart Disease

Background:

• Mild or moderate secondary tricuspid regurgitation (TR) with a dilated annulus is common in patients undergoing major cardiac surgery.
• The impact of concomitant tricuspid annuloplasty on perioperative outcomes and right ventricular (RV) function in these patients remains debated.

Purpose of the Study:

• To evaluate the effect of concomitant tricuspid annuloplasty on perioperative outcomes and RV function in patients with mild or moderate secondary TR and a dilated annulus undergoing major cardiac surgery.

Main Methods:

• A retrospective analysis of 324 patients with mild or moderate secondary TR and a dilated annulus (≥40 mm or >21 mm/m2) who underwent major cardiac surgery between 2000 and 2016.
• Patients were divided into two groups: those who underwent concomitant tricuspid annuloplasty (n=184) and those who did not (n=140).
• Propensity score matching was used to compare outcomes between the groups.

Main Results:

• Perioperative mortality was similar between the groups (4.4% with repair vs. 5.7% without).
• Mid-term mortality showed no significant difference.
• Patients who underwent tricuspid annuloplasty had significantly less TR post-surgery and demonstrated improved right ventricular function compared to the non-repair group.

Conclusions:

• Concomitant tricuspid annuloplasty in patients with mild or moderate secondary TR and a dilated annulus does not elevate perioperative risk.
• Tricuspid valve repair in this specific patient subgroup leads to improved right ventricular function.
• Routine consideration of tricuspid repair in these patients may be warranted.