Impact of Tricuspid Regurgitation on Outcomes After Cox-Maze IV Procedure

Patients undergoing mitral valve surgery with atrial fibrillation commonly have a concomitant Cox-maze IV procedure (CMP-IV). Secondary tricuspid regurgitation (TR) is frequently present. This study evaluated the impact of preoperative TR on outcomes after the CMP-IV.

Between January 2002 and November 2023, 407 patients underwent concomitant mitral valve surgery with CMP-IV. Patients were grouped by preoperative TR severity: moderate or severe TR (TR group) and less than moderate (non-TR group). Propensity score matching was performed to balance baseline characteristics. Perioperative and late outcomes were compared in the unmatched and matched cohorts.

Of all patients, 108 (27%) had moderate or severe TR, and 48 (45%) of them received tricuspid valve surgery. The TR group had more patients in New York Heart Association Functional Classification III and IV (70% vs 57%; standardized mean difference, 0.291). Postoperatively, TR patients had more permanent pacemaker placements (18% vs 10%; P = .036), renal failure requiring dialysis (12% vs 5%; P = .028), and 30-day mortality (7% vs 1%; P = .004). At 10 years, TR patients demonstrated worse freedom from atrial tachyarrhythmias off antiarrhythmic drugs (32% vs 63%; P = .031). After propensity score matching, 30-day mortality (9% vs 1%; P = .004) and atrial tachyarrhythmias-free survival (45% vs 24%; P = .004) at 10 years were worse in TR patients.

In patients undergoing the concomitant CMP-IV procedure with mitral valve surgery, preoperative TR worsened both early and late survival and freedom from recurrent atrial tachyarrhythmias. These worse outcomes were not impacted by performing concomitant tricuspid valve surgery.