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March 1, 2025JACC AsiaOpen Access

Concomitant tricuspid repair during mitral surgery fails to reduce moderate TR but is linked to AF.

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Why the study?

Whether tricuspid valve repair should be performed during degenerative mitral valve repair in patients with less than moderate regurgitation remains controversial.

Does concomitant tricuspid valve repair prevent the development of moderate tricuspid regurgitation in patients with less than moderate tricuspid regurgitation undergoing degenerative mitral valve repair?

Population

541 patients with less than moderate TR undergoing mitral valve repair for degenerative mitral disease

Comparison

Concomitant TV repair vs no TV repair

Design

Propensity score-matched cohort study

Follow-up

Median 8 years

Key result

Concomitant tricuspid valve repair during degenerative mitral valve surgery for less than moderate tricuspid regurgitation did not significantly reduce the development of moderate tricuspid regurgitation (HR 0.323) but increased the risk of new-onset atrial fibrillation.

Authors

JDJinren DuYZYichen ZhaoKLKemin Liu

Discussion

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Member takes

Overview

Concomitant TV repair was associated with no TR benefit but higher AF risk; should not change practice and leaves open need for RCTs.

Study Design

Type

Cohort (n=541)

Multicenter

No

Structured PICO

Does concomitant tricuspid valve repair prevent the development of moderate tricuspid regurgitation in patients with less than moderate tricuspid regurgitation undergoing degenerative mitral valve repair?

P
Population
541 patients with less than moderate tricuspid regurgitation (TR) undergoing mitral valve repair for degenerative mitral disease at a single center.
I
Intervention
Concomitant tricuspid valve (TV) repair during mitral valve repair.
C
Comparator
No concomitant tricuspid valve repair (mitral valve repair only).
O
Outcome
Development of moderate tricuspid regurgitation (TR).surrogate

Main Result

Effect estimate: HR 0.323 (95% CI 0.093-1.127)

Absolute Event Rate: 1% vs 3.9%

p-value: p=0.125

Concomitant tricuspid valve repair during degenerative mitral valve surgery for less than moderate TR does not prevent future TR progression and increases the risk of new-onset atrial fibrillation.

Limitations

  • Single-center retrospective study subject to inherent biases
  • Echocardiography and ECG data could not be continuously obtained during follow-up
  • Some patients were not regularly re-examined, reducing the accuracy of the occurrence time of endpoints

Cite This Study

Du et al. (2025) conducted a cohort in Degenerative mitral disease with less than moderate tricuspid regurgitation (n=541). Concomitant tricuspid valve repair vs. No tricuspid valve repair was evaluated on Development of moderate tricuspid regurgitation (HR 0.323, 95% CI 0.093-1.127, p=0.125). Concomitant tricuspid valve repair during degenerative mitral valve surgery for less than moderate tricuspid regurgitation did not significantly reduce the development of moderate tricuspid regurgitation (HR 0.323) but increased the risk of new-onset atrial fibrillation.

synapsesocial.com/papers/6a158582d64fa333899fc3e4https://doi.org/10.1016/j.jacasi.2025.01.012
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