Concomitant Tricuspid Annuloplasty During Mitral Surgery: Becoming an Unpopular Practice?

Concomitant tricuspid annuloplasty (TA) during surgery for degenerative mitral regurgitation remains debated. A recent Cardiothoracic Surgical Trials Network trial demonstrated a reduction in tricuspid regurgitation with concomitant TA, with no mortality or quality of life benefit and a significantly higher risk of permanent pacemaker placement. We sought to quantify the rate of TA in eligible patients after publication of these trial results.

Using a regional collaborative, we identified all patients between 2017 and 2023 with degenerative mitral regurgitation undergoing mitral valve repair or replacement. We included only those patients with moderate tricuspid regurgitation. Those with endocarditis, primary tricuspid regurgitation, severe tricuspid regurgitation, or an undocumented degree of tricuspid regurgitation were excluded. Our time event was the trial publication date. A 1-month washout period before and after the time of publication was used to account for change in surgeon practice.

We identified 204 patients who met inclusion criteria, with 57 patients (27.9%) undergoing surgery in the posttrial period. The rate of tricuspid repair in the pretrial group was 45.6% compared with 26.3% in the posttrial group (P = .01). Baseline demographics and comorbidities between the groups were similar. All postoperative outcomes, including operative mortality, were similar (P > .05).

In a comparative group of patients with moderate tricuspid regurgitation undergoing mitral valve surgery, there was a significant decrease in concomitant tricuspid valve interventions after the Cardiothoracic Surgical Trials Network trial publication.