Should moderate tricuspid regurgitation be repaired at the time of mitral surgery? Results from a large...

To trace the temporal trajectory of unrepaired moderate tricuspid regurgitation (TR) after primary, isolated mitral valve repair (MVr) alone compared with none or mild TR, and to determine whether moderate TR is associated with worse survival.

Between January 1, 2000, and December 21, 2022, a total of 5467 consecutive patients (mean age, 58 ±12 years) with severe degenerative mitral regurgitation (MR) underwent MVr alone without concomitant TR repair. Of these, 3418 (63%) had no TR, 1652 (30%) had mild TR, and 397 (7%) had moderate TR. They were followed prospectively for a maximum duration of 24 years.

Patients with preoperative moderate TR had an increased unadjusted risk of mortality (70% survival) at 14 years compared to patients with mild TR (81% survival) and those with no TR (85% survival), mostly related to a higher baseline risk profile. Patients who died during follow-up were more likely to have moderate TR compared to those who survived. Among patients with unaddressed moderate preoperative TR, the proportion with persistent moderate TR dropped to 19% (from 100%) immediately after MVr and then increased to 31% at 10 years. Degree of preoperative TR and postoperative MR were associated with moderate or greater TR during follow-up.

Patients with untreated preoperative moderate TR undergoing isolated MV surgery had incomplete resolution of their TR. The presence of moderate TR during follow-up was associated with increased mortality at long-term follow-up, mostly related to a higher baseline risk profile. MR perhaps should be treated before the development of moderate TR.