Key result
Concomitant tricuspid repair cuts TR progression at 2 years but increases pacemaker implantation.
Why the study?
Management of tricuspid regurgitation and annular dilation during mitral valve repair remains controversial with unclear indications for concomitant tricuspid valve repair.
Does concomitant tricuspid valve repair during mitral valve repair reduce tricuspid regurgitation progression or improve late survival in patients with moderate tricuspid regurgitation or annular dilation?
Does concomitant tricuspid valve repair during mitral valve repair reduce tricuspid regurgitation progression or improve late survival in patients with moderate tricuspid regurgitation or annular dilation?
Concomitant tricuspid valve repair for moderate TR during mitral surgery reduces TR progression at the cost of higher pacemaker risk, while intervening on mild TR based solely on annular dilation provides no apparent benefit, challenging current surgical guidelines.
May reduce TR progression without survival benefit; leaves open optimal strategy for moderate TR during mitral repair.
PURPOSE OF REVIEW: Management of tricuspid regurgitation and annular dilation during mitral valve repair remains controversial. We review the latest evidence on indications to repair the tricuspid valve during mitral valve repair and discuss surgical strategies and complications. RECENT FINDINGS: Concomitant tricuspid valve repair of moderate tricuspid regurgitation is effective in reducing tricuspid regurgitation progression at 2 years, but has not shown benefit to late survival, quality of life, or functional benefit, and is associated with increased permanent pacemaker implantation (PPM) rates, which is associated with reduced late survival. Progression of less than moderate tricuspid regurgitation with annular dilation alone is uncommon, obviating the need for concomitant repair. SUMMARY: Repairing concomitant moderate tricuspid regurgitation at the time of mitral repair reduces tricuspid regurgitation progression at 2 years, at the cost of a higher PPM implantation rate. However, repairing less than moderate tricuspid regurgitation for annular dilation alone has not been shown to reduce tricuspid regurgitation progression, bringing current guideline recommendations surrounding repair for annular dilation into question. Longer-term follow-up data, at 5 years, will shed further light on this topic.
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An et al. (2024) conducted a review in Tricuspid regurgitation and annular dilation during mitral valve repair. Concomitant tricuspid valve repair was evaluated on Tricuspid regurgitation progression. Concomitant tricuspid valve repair during mitral repair reduces progression of moderate tricuspid regurgitation at 2 years but increases permanent pacemaker implantation rates.
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