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Tricuspid Annuloplasty: Is It a Step That Should Not Be Ignored in Mitral Valve Surgery?
Mustafa Sabri Bayram1, Serkan Yildirim1, Mehmet Işik1
1Necmettin Erbakan University School of Medicine, Department of Cardiovascular Surgery, Necmettin Erbakan University, Meram 42100, Konya.
Objectives:
Tricuspid regurgitation (TR) is commonly encountered in patients with left-sided valve disease and often progresses postoperatively if left unaddressed. While mitral valve replacement (MVR) alone may improve left heart parameters, concomitant tricuspid ring annuloplasty (TRA) might prevent right-sided deterioration.
Methods:
This retrospective study analysed 129 patients undergoing MVR between 2016 and 2019. Patients were divided into 2 groups: isolated MVR (n = 71) and MVR + TRA (n = 58). Long-term echocardiographic outcomes were compared, including LVDD, LVSD, LVEF, LA diameter, IVS thickness, pulmonary flow rate, PAP, and TI degree.
Results:
Both the groups showed regression in left heart dimensions postoperatively; however, left ventricular ejection fraction (LVEF) significantly decreased in the MVR-only group (P < .001) while it remained stable in the MVR + TRA group (P =0.598). Severe tricuspid insufficiency occurred in 12% (95% CI 5%-21%) of patients undergoing isolated MVR and 0% (95% CI 0%-6 ) of those undergoing MVR + TRA (P < .001). The mean difference in the change of pulmonary artery pressure (ΔPAP) between the groups was 12.0 mmHg (95% CI 6.5-17.3, P = .002), and both pulmonary artery pressure and left atrial diameter significantly decreased postoperatively in the MVR + TRA group.
Conclusions:
Performing TRA during MVR surgery offers significant protective effects against TI progression and right heart overload. Even in cases with mild TI but annular dilation, simultaneous TRA may be a rational and beneficial strategy to ensure long-term cardiac stability.
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