Mild-to-moderate functional tricuspid regurgitation in patients undergoing valve replacement for rheumatic mitral disease: the influence of tricuspid valve repair on clinical and echocardiographic outcomes

BACKGROUND: The decision to repair mild-to-moderate functional tricuspid regurgitation (TR) during left-side heart surgery remains controversial. Objectives To avoid heterogeneity in patient population, patients with TR undergoing isolated mechanical mitral valve (MV) replacement for rheumatic mitral diseases were evaluated. METHODS: Between 1997 and 2009, 236 patients with mild-to-moderate functional TR underwent first-time isolated mechanical MV replacement for rheumatic mitral diseases with (n=123; repair group) or without (n=113; non-repair group) tricuspid valve (TV) repair. Survival, valve-related complications, and TV function in these two groups were compared after adjustment for baseline characteristics using inverse-probability-of-treatment weighting. RESULTS: Follow-up was complete in 225 patients (95.3%) with a median follow-up of 48.7 months (IQR 20.2-89.5 months), during which time 991 echocardiographic assessments were done. Freedom from moderate-to-severe TR at 5 years was 92.9±2.9% in the repair group and 60.8±6.9% in the non-repair group (p<0.001 and 0.048 in crude and adjusted analyses, respectively). After adjustment, both groups had similar risks of death (HR=0.57, p=0.43), tricuspid reoperation (HR=0.10, p=0.080) and congestive heart failure (HR=1.12, p=0.87). Postoperative moderate-to-severe TR was an independent predictor of poorer event-free survival (HR=2.90, p=0.038). CONCLUSIONS: These findings support the strategy of correcting mild-to-moderate functional TR at the time of MV replacement to maintain TV function and improve clinical outcomes.