Concomitant tricuspid valve repair during mitral valve replacement significantly reduced TR progression, with 92% of patients showing no TR at 12 months versus 0% with MVR alone (P<0.001).
RCT (n=50)
randomized
Does concomitant tricuspid valve repair during mitral valve replacement reduce tricuspid regurgitation progression and improve right ventricular function in patients with severe rheumatic mitral stenosis and moderate functional tricuspid regurgitation?
Concomitant tricuspid valve repair during mitral valve replacement for moderate functional tricuspid regurgitation significantly reduces disease progression and improves right ventricular hemodynamics at 1 year.
Tasa de eventos absoluta: 92% vs 0%
valor p: p=<0.001
Background and aim Tricuspid regurgitation (TR) is a common complication in patients with severe rheumatic mitral stenosis, yet the management of moderate functional TR during mitral valve replacement (MVR) remains debated. While severe TR is routinely addressed, moderate TR is often overlooked despite its potential to progress and worsen outcomes. We aimed to compare the progression of TR and clinical outcomes in patients undergoing MVR with or without concomitant tricuspid valve repair (TVR) for moderate functional TR. Patients and methods A total of 50 patients with severe rheumatic mitral stenosis and moderate functional TR were prospectively randomized into two groups: group A ( n =25) underwent MVR with TVR (DeVega annuloplasty), and group B ( n =25) underwent MVR alone. Clinical and echocardiographic evaluations were performed preoperatively and at 3, 6, and 12 months postoperatively. Results Group A demonstrated significant improvements compared with group B. TR progression was markedly reduced, with 92% of repair-group patients showing no TR at 12 months versus 0% in the nonrepair group ( P <0.001). Right ventricular function improved, reflected by increased tricuspid annular plane systolic excursion (23.12±0.88 vs. 18.12±1.01 mm, P <0.001). Pulmonary artery systolic pressure decreased significantly in the repair group (32.6±10.37 vs. 46.28±10.06 mmHg, P <0.001). Conclusions Concomitant TVR during MVR in patients with moderate functional TR significantly reduces TR progression, improves right ventricular function, and alleviates symptoms of right-sided heart failure.
Khalifa et al. (Thu,) conducted a rct in severe rheumatic mitral stenosis and moderate functional tricuspid regurgitation (n=50). Mitral valve replacement with tricuspid valve repair (DeVega annuloplasty) vs. Mitral valve replacement alone was evaluated on No tricuspid regurgitation at 12 months (p=<0.001). Concomitant tricuspid valve repair during mitral valve replacement significantly reduced TR progression, with 92% of patients showing no TR at 12 months versus 0% with MVR alone (P<0.001).