Key result
Concomitant tricuspid annuloplasty during mitral repair cuts TR progression despite higher pacemaker need.
Why the study?
The role of concomitant tricuspid annuloplasty during mitral valve repair for degenerative mitral regurgitation remains controversial.
Does the addition of concomitant tricuspid annuloplasty during mitral valve repair improve survival, reduce tricuspid regurgitation progression, and affect permanent pacemaker implantation rates in patients with degenerative mitral regurgitation?
Meta-Analysis (n=3,123)
Yes
Does the addition of concomitant tricuspid annuloplasty during mitral valve repair improve survival, reduce tricuspid regurgitation progression, and affect permanent pacemaker implantation rates in patients with degenerative mitral regurgitation?
In patients with degenerative mitral regurgitation undergoing mitral valve repair, performing a concomitant tricuspid annuloplasty effectively prevents long-term progression of tricuspid regurgitation without affecting survival, though it carries a markedly increased risk of permanent pacemaker implantation.
Supports concomitant annuloplasty in degenerative mitral repair to prevent TR progression; extends meta-analytic evidence while flagging pacemaker risk.
Tricuspid regurgitation (TR) is common among patients undergoing surgery for degenerative mitral regurgitation (DMR) and is associated with adverse outcomes. The role of concomitant tricuspid annuloplasty (TA) during mitral valve repair (MVr) remains controversial. To address this, we performed a systematic review and meta-analysis of randomized and observational studies published up to November 2024, comparing isolated MVr versus MVr with concomitant TA in patients with DMR (CRD42024627505). Reconstructed Kaplan-Meier time-to-event data were analyzed using Cox frailty models to evaluate survival, TR progression, and permanent pacemaker (PPM) implantation. Sensitivity analyses included randomized or propensity-matched cohorts. A total of 5 studies, including 3,123 patients, were analyzed. Early (1-year) and long-term (up to 15 years) survival were comparable between isolated MVr and concomitant TA (97.3% vs. 96.9%, HR: 1.25, 95% CI: 0.76 to 2.08, p = 0.381 and 72.2% vs 79.7%, HR: 1.28, 95% CI: 0.96 to 1.72, p = 0.092, respectively). Concomitant TA significantly reduced the risk of ≥moderate TR progression (HR: 0.34, 95% CI: 0.17 to 0.70, p = 0.003). However, PPM implantation was higher with TA during the perioperative period (7.4% vs 1.1%, HR 5.76, 95% CI 3.13 to 10.59) and remained elevated at 2 years. Sensitivity analyses confirmed these findings. In conclusion, in patients undergoing MVr for DMR, concomitant TA effectively prevents TR progression without compromising survival but is associated with increased PPM implantation. These results support a selective, guideline-directed approach to TA based on patient- and disease-specific risk factors.
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Jacquemyn et al. (2025) conducted a meta-analysis in Degenerative mitral regurgitation (DMR) (n=3,123). Concomitant tricuspid annuloplasty (TA) vs. Isolated mitral valve repair (MVr) was evaluated on Early (1-year) survival (HR 1.25, 95% CI 0.76-2.08, p=0.381). Concomitant tricuspid annuloplasty during degenerative mitral valve repair significantly reduced the risk of ≥moderate TR progression (HR 0.34) without compromising survival, but increased perioperative permanent pacemaker implantation.
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