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. 2023 Dec 27;2(3):341-346.
doi: 10.1016/j.atssr.2023.12.005. eCollection 2024 Sep.

Concomitant Tricuspid Valve Surgery With Mitral Valve Surgery for Moderate Tricuspid Regurgitation

Jake Awtry  1   2 , Paige Newell  1   2 , Sameer Hirji  1 , Hoda Javadikasgari  1 , Siobhan McGurk  1 , Sary Aranki  1 , Ashraf Sabe  1 , Tsuyoshi Kaneko  3
Affiliations

Concomitant Tricuspid Valve Surgery With Mitral Valve Surgery for Moderate Tricuspid Regurgitation

Jake Awtry et al. Ann Thorac Surg Short Rep. .

Abstract

Background: Tricuspid valve surgical procedures (TVS) concomitant with mitral valve (MV) surgical procedures for less than severe tricuspid regurgitation (TR) remains controversial. This study examined the long-term outcomes of patients with moderate or mild to moderate TR undergoing MV surgical procedures with or without TVS.

Methods: Patients with moderate or mild to moderate TR undergoing MV replacement or repair between January 2002 and June 2021 were included. Primary outcomes of reoperation and long-term survival were compared for patients undergoing MV replacement or repair with or without TVS before and after stratifying by mitral disease cause.

Results: The study included 505 patients. Mean age was 69 ± 12.7 years. The Society of Thoracic Surgeons Predicted Risk of Mortality for MV replacement (3.71 vs 4.39; P = .34) and repair (1.73 vs 1.67; P = .84) was similar for patients who did and did not undergo TVS. Operative mortality was similar for replacement (4.2% vs 6.1%; P = .77) or repair (0% vs 0%) with or without TVS. Patients undergoing MV replacement or repair with or without TVS had similar 10-year survival (67.1% vs 73.2% [P = .37]; 68.7% vs 78.8% [P = .052]) and rates of reoperation (2.1% vs 0.8% [P = .69]; 4.9% vs 4.6% [P = .99]). Cox proportional hazards modeling confirmed that TVS did not decrease the risk of death after MV replacement (hazard ratio, 0.839 [0.479-1.467]) or repair (hazard ratio, 0.852 [0.516-1.408]). The findings were unchanged after stratifying by MV disease cause or restricting the analysis to patients with moderate TR only, with no differences in survival or reoperation (all P > .05).

Conclusions: Concomitant TVS for moderate or mild to moderate TR did not improve survival or decrease reoperation. Parameters beyond the degree of TR may aid in surgical decision-making.

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Figures

Figure 1
Figure 1
Kaplan-Meier and Cox proportional hazards modeling survival analysis after mitral valve (A, C) replacement or (B, D) repair with or without tricuspid valve surgery (TVS). Hazard ratio (HR) calculated after adjustment for propensity to undergo tricuspid valve surgery.
Figure 2
Figure 2
Competing risk analysis for reoperation vs death after mitral valve (A) replacement or (B) repair with or without tricuspid valve surgery (TVS).
See this image and copyright information in PMC

References

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