Behavior of mitral regurgitation after isolated tricuspid valve surgery: determinants and hemodynamic correlates

Isolated tricuspid regurgitation (TR) is increasingly recognized as a clinically important disease associated with adverse outcomes. Surgical repair often improves right-sided hemodynamics, but its effects on mitral regurgitation (MR) are unclear. Early observations suggest that MR may worsen postoperatively, yet reliable predictors remain insufficiently defined.

To evaluate postoperative MR behavior following isolated surgical TR repair and identify echocardiographic predictors of MR worsening.

This retrospective cohort study included patients ≥ 14 years who underwent isolated tricuspid valve repair between 2012 and 2023 at a tertiary center. Complete paired pre- and postoperative echocardiograms were analyzed by a blinded cardiologist. MR worsening was defined as an increase of ≥ 1 grade. Paired nonparametric tests compared pre- and postoperative echocardiographic indices, and between-group analyses examined factors associated with MR progression.

Nineteen patients (mean age 36.3 years; 63% male) met the inclusion criteria. TR severity improved significantly after surgery (p < 0.001), accompanied by marked right-ventricular reverse remodeling, including significant reductions in RV size (p = 0.001) and RVIDd (4.60 ± 0.58 to 3.89 ± 0.44 cm; p < 0.001). MR severity changed significantly in paired analysis (p = 0.010), and 63% of patients demonstrated postoperative worsening. Left-sided chamber dimensions and systolic function remained stable. Among all parameters assessed, only postoperative E/e' differed significantly between patients with and without MR worsening (9.39 ± 2.32 vs. 7.16 ± 0.65; p = 0.045).

In this small exploratory cohort, postoperative MR worsening occurred in a notable subset of patients, although the clinical relevance of these changes remains uncertain.Among the evaluated parameters, postoperative E/e' was higher in patients with MR worsening, suggesting a possible association between elevated LV filling pressures and postoperative MR behavior. Routine postoperative surveillance may be warranted to detect clinically relevant MR changes.