Repairing Tricuspid valve During MV Surgery prevents Tricuspid Regurgitation progression

There are concerns that if mild or moderate TR is not fixed at the time of surgery, it might progress and result in adverse outcomes, such as an increased risk of death or worsening functional outcomes. However, the indication for tricuspid valve intervention for less-than-severe TR in the absence of right-heart failure or significant tricuspid annulus dilation is less clear. Therefore, Dr Irsa Hasan and her team conducted a study to further assess the impact of tricuspid repair during MV surgery.

In a retrospective analysis, the researchers included 1588patients undergoing MV surgery with and without tricuspid surgery between 2001 and 2018. They included patients with preoperative transthoracic (TTE) and at least one postoperative TTE (within 6 months). Of 1,588 patients, 25% had moderate TR and, 7% had severe TR. Among the 404 patients with moderate TR—the focus of the analysis—103 patients had concomitant tricuspid valve surgery and, 301 were left untreated.

Key findings of the study:

• Upon analysis, the researchers noted that 40% of patients with moderate TR who underwent concomitant tricuspid valve surgery had their TR grade reduced to mild and 50% had only trivial or no TR at all in early postoperative TTE follow-up.
• Among those untreated, they noted that 6.6% had severe TR, 43.6% had moderate TR, and 34.6% had mild TR on postoperative TTE.
• Compared with patients who didn't have moderate TR treated during surgery, they found that the probability of worsening TR increased with time and these trends were generally similar for all of the preoperative [TR] grades.

Regarding the long-term follow-up, those who had moderate TR treated during MV surgery had generally a similar risk or probability of moderate or greater TR at 5, 10, and 15 years, said Hasan. She further added, "Interestingly, the risk of progression to severe TR was not influenced by the size of tricuspid annulus diameter, but a diagnosis of preoperative congestive heart failure was associated with severe TR progression."

For further information:

Hasan I, Crestanello J, Daly R, et al. Impact of tricuspid regurgitation on late outcomes of mitral surgery. Presented at: STS 2022.