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Concomitant Tricuspid Valve Surgery With Mitral Valve Surgery for Moderate Tricuspid Regurgitation
Jake Awtry1,2, Paige Newell1,2, Sameer Hirji1
1Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
Annals of Thoracic Surgery Short Reports
|January 10, 2025
Summary
Tricuspid valve surgery (TVS) with mitral valve surgery for moderate TR does not improve survival or reduce reoperation rates. Surgical decisions should consider factors beyond just the degree of tricuspid regurgitation.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Outcomes
- Valvular Heart Disease
Background:
- Tricuspid valve surgery (TVS) concomitant with mitral valve (MV) surgery for less than severe tricuspid regurgitation (TR) is debated.
- This study investigates long-term outcomes in patients with moderate or mild to moderate TR undergoing MV procedures with or without TVS.
Purpose of the Study:
- To evaluate the impact of concomitant tricuspid valve surgery on long-term survival and reoperation rates in patients undergoing mitral valve surgery for moderate or mild to moderate tricuspid regurgitation.
- To determine if TVS offers additional benefit beyond MV surgery in this patient population.
Main Methods:
- A retrospective analysis of 505 patients undergoing MV replacement or repair between 2002 and 2021.
- Comparison of primary outcomes (reoperation, long-term survival) between patients who underwent TVS and those who did not, stratified by mitral disease cause.
- Cox proportional hazards modeling was used to assess the risk of death.
Main Results:
- Concomitant TVS was associated with similar operative mortality, 10-year survival, and reoperation rates compared to MV surgery alone.
- Cox modeling indicated TVS did not decrease the risk of death after either MV replacement or repair.
- These findings remained consistent after stratification by MV disease cause or focusing solely on moderate TR patients.
Conclusions:
- Concomitant tricuspid valve surgery for moderate or mild to moderate TR does not improve survival or reduce reoperation rates following mitral valve surgery.
- Surgical decision-making for concomitant TVS should incorporate parameters beyond the degree of tricuspid regurgitation.
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