Mitral Valve Repair for Degenerative MR With Moderate or Less Tricuspid Regurgitation

Key indicators of the quality of mitral valve (MV) repair for degenerative mitral regurgitation (DMR) are the presence and degree of recurrent (mitral regurgitation (MR) during follow-up, but few studies have provided longitudinal echocardiographic core laboratory–adjudicated data. The purpose of this study was to evaluate 2-year survival and MR recurrence in patients who underwent MV repair for DMR with concomitant tricuspid valve (TV) disease between 2016 and 2018. This is a post hoc analysis of outcomes from a randomized trial (N = 401; 39 sites) evaluating the effects of TV repair during MV surgery for patients with DMR and moderate or less tricuspid regurgitation. Eighty-seven patients (21.7%) were excluded because they underwent MV replacement (32 planned and 9 conversions) or did not have isolated DMR or evaluable echocardiographic data during 2 years. The primary endpoint was a composite of the incidence of all-cause mortality, recurrent severe MR, or MV reoperation (ie, treatment failure) during 2 years. Multivariable modeling identified risk factors for recurrent MR. Among 314 eligible patients (median age: 67.4; female: 24.2%), 1.0% (3 of 307) had moderate MR and 0.7% (2 of 307) had severe MR at discharge. Thirty-day all-cause mortality rate was 1.0%. At 2 years, 3.5% (11 of 314) had died, and 2.2% (7 of 314) had MV reoperation. Among 295 survivors free of MV reoperation with evaluable echocardiograms, 9.2% (27 of 295) had moderate MR, 1.4% (4 of 295) had severe MR, and 2.5% (7 of 275) had a mean MV gradient >5 mm Hg. The incidence of death, MV reoperation, or severe MR during 2 years was 8.0% (25 of 313). Patients with anterior or bileaflet MV pathology were at higher risk for treatment failure compared with patients with posterior leaflet pathology (OR: 2.48; 95% CI: 1.09-5.68; P = 0.03). In this international trial with echocardiographic core laboratory adjudication, the rate of survival free from MV reoperation or any episode of severe MR during 2 years was 92% in patients with DMR and concomitant TV disease. These outcomes show that surgical repair achieves high success and durability during 2 years in these patients, providing a contemporary benchmark for clinical decision-making and future trials. (Evaluating the Benefit of Concurrent Tricuspid Valve Repair During Mitral Surgery; NCT02675244 )