Key result
Prophylactic tricuspid annuloplasty during mitral surgery reduces 5-year >mild TR to ~0% vs conservative treatment.
Why the study?
Does prophylactic tricuspid annuloplasty prevent moderate or severe functional tricuspid regurgitation in patients with less-than-severe FTR undergoing mitral valve surgery?
RCT (n=106)
No
Does prophylactic tricuspid annuloplasty prevent moderate or severe functional tricuspid regurgitation in patients with less-than-severe FTR undergoing mitral valve surgery?
Prophylactic tricuspid annuloplasty during mitral valve surgery significantly reduces the recurrence of moderate or severe functional tricuspid regurgitation at 5 years, although it does not improve functional capacity or right ventricular function.
May support prophylactic tricuspid annuloplasty evaluation in mitral surgery; leaves open randomized confirmation of clinical benefit.
OBJECTIVES: The optimal management of functional tricuspid regurgitation (FTR) in the setting of mitral valve operations remains controversial. The current practice is both centre specific and surgeon specific with guidelines based on non-randomized data. A prospective randomized trial was performed to evaluate the worth of less-than-severe FTR repair during mitral valve procedures. METHODS: A single-centre randomized study was designed to allocate patients with less-than-severe FTR undergoing mitral valve surgery to be prophylactically treated with or without tricuspid valve annuloplasty (TVP- or TVP+). These patients were analysed using longitudinal cardiopulmonary exercise capacity, echocardiographic follow-up and cardiac magnetic resonance. The primary outcome was freedom from more than or equal to moderate tricuspid regurgitation with vena contracta ≥4 mm. Secondary outcomes were maximal oxygen uptake and right ventricular (RV) dimension and function. RESULTS: A total of 53 patients were allocated to receive concomitant TVP+, and 53 patients were treated conservatively (TVP-). At 5 years, tricuspid regurgitation was observed to be greater than mild in 10 patients in the TVP- group and no patients in the TVP+ group (P < 0.01). Maximal oxygen uptake, RV basal diameter, end-diastolic diameter and end-systolic diameter and fractional area changes were similar in both groups. Cardiac magnetic resonance confirmed no differences in RV end-diastolic volume, RV end-systolic volume and RV ejection fraction. CONCLUSIONS: This single-centre prospective randomized trial demonstrated that prophylactic tricuspid annuloplasty irrespective of annular dilatation at the time of mitral surgery reduced the recurrence of moderate or severe FTR at 5-year follow-up and reduced the pulmonary pressure. Nevertheless, the functional capacity, the RV function and the RV dimension remained similar.
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Pettinari et al. (2018) conducted an RCT in Less-than-severe functional tricuspid regurgitation (n=106). Prophylactic tricuspid valve annuloplasty vs. Conservative treatment without tricuspid valve annuloplasty was evaluated on Freedom from more than or equal to moderate tricuspid regurgitation with vena contracta ≥4 mm (p=< 0.01). Prophylactic tricuspid annuloplasty during mitral valve surgery reduced the incidence of greater than mild tricuspid regurgitation at 5 years compared to conservative treatment (0% vs 18.9%; P<0.01).
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