Key result
Preoperative moderate or severe tricuspid regurgitation was associated with significantly worse 10-year atrial tachyarrhythmias-free survival (24% vs 45%, P=0.004) compared to less severe tricuspid regurgitation.
Why the study?
The impact of preoperative tricuspid regurgitation on outcomes after concomitant Cox-maze IV procedure with mitral valve surgery was unclear.
Does moderate or severe preoperative tricuspid regurgitation worsen long-term outcomes in patients undergoing concomitant mitral valve surgery and Cox-maze IV procedure?
Cohort (n=407)
No
Does moderate or severe preoperative tricuspid regurgitation worsen long-term outcomes in patients undergoing concomitant mitral valve surgery and Cox-maze IV procedure?
Moderate or severe preoperative secondary tricuspid regurgitation predicts worse long-term survival and higher atrial arrhythmia recurrence after concomitant mitral valve and Cox-maze IV surgeries, outcomes that are not salvaged by simply adding a tricuspid valve procedure.
Moderate/severe preoperative TR was associated with worse long-term arrhythmia-free survival after mitral surgery plus Cox-maze IV; leaves open whether tricuspid intervention mitigates recurrence.
BACKGROUND: Patients undergoing mitral valve surgery with atrial fibrillation commonly have a concomitant Cox-maze IV procedure (CMP-IV). Secondary tricuspid regurgitation (TR) is frequently present. This study evaluated the impact of preoperative TR on outcomes after the CMP-IV. METHODS: Between January 2002 and November 2023, 407 patients underwent concomitant mitral valve surgery with CMP-IV. Patients were grouped by preoperative TR severity: moderate or severe TR (TR group) and less than moderate (non-TR group). Propensity score matching was performed to balance baseline characteristics. Perioperative and late outcomes were compared in the unmatched and matched cohorts. RESULTS: Of all patients, 108 (27%) had moderate or severe TR, and 48 (45%) of them received tricuspid valve surgery. The TR group had more patients in New York Heart Association Functional Classification III and IV (70% vs 57%; standardized mean difference, 0.291). Postoperatively, TR patients had more permanent pacemaker placements (18% vs 10%; P = .036), renal failure requiring dialysis (12% vs 5%; P = .028), and 30-day mortality (7% vs 1%; P = .004). At 10 years, TR patients demonstrated worse freedom from atrial tachyarrhythmias off antiarrhythmic drugs (32% vs 63%; P = .031). After propensity score matching, 30-day mortality (9% vs 1%; P = .004) and atrial tachyarrhythmias-free survival (45% vs 24%; P = .004) at 10 years were worse in TR patients. CONCLUSIONS: In patients undergoing the concomitant CMP-IV procedure with mitral valve surgery, preoperative TR worsened both early and late survival and freedom from recurrent atrial tachyarrhythmias. These worse outcomes were not impacted by performing concomitant tricuspid valve surgery.
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Yi et al. (2025) conducted a cohort in Atrial fibrillation and mitral valve disease requiring concomitant surgery (n=407). Moderate or severe preoperative secondary tricuspid regurgitation vs. Less than moderate preoperative tricuspid regurgitation was evaluated on Atrial tachyarrhythmias-free survival at 10 years (propensity matched) (p=0.004). Preoperative moderate or severe tricuspid regurgitation was associated with significantly worse 10-year atrial tachyarrhythmias-free survival (24% vs 45%, P=0.004) compared to less severe tricuspid regurgitation.
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