The influence of mitral valve pathology on the concomitant tricuspid valve repair

Abstract

Background: The influence of the etiology of mitral valve (MV) lesion on outcomes of concomitant repair for functional tricuspid regurgitation (TR) is not well studied.Our objectives were to compare long-term survival and TR recurrence after tricuspid valve (TV) repair concomitant with surgery for rheumatic versus degenerative MV disease.Methods: We included 480 patients who had concomitant MV and TV surgery from 2009 to 2019. We grouped the patients into Group 1 (n = 345; rheumatic MV) and Group 2 (n = 135; degenerative MV). Propensity score matching identified 104 matched pairs.Results: There was no significant difference in survival between groups before

Balancing the Benefits of Tricuspid Annuloplasty

“…The cumulative incidence of death in Arafat et al series at 7 years was 4.8% (10). Similar studies were conducted by Farooq and Bernal and their colleagues in younger patients at a mean age of 41-46 years, the 30-day mortality was 4.5 -5.9% (11,12).…”

“…The article published in this edition of Journal of Cardiac Surgery, Arafat and colleagues discuss the results of their ten year clinical experience of concomitant tricuspid annuloplasty (TA) for moderate to severe tricuspid regurgitation (TR) during mitral valve surgery in patients with rheumatic (RMVD -n= 345; 61% had mitral regurgitation and 39% mitral valve stenosis) and degenerative (DMVD n= 135) mitral valve diseases, The objective of the observational non-randomized trial was to identify predictors of durability of TA for moderate to severe TR in patients with RMVD and DMVD undergoing mitral valve repairs and replacements. Valve repair was feasible in 12% in the RMVD group as compared to 52% in DMVD group (10). The TA was performed with flexible, rigid prostheses and the de Vega suture technique.…”

“…Although it is a single centre observational trial like others, which they admit, their data provide valuable information that stimulates discussions in the clinical practice, which encourages early aggressive approach for concomitant tricuspid annuloplasty (TA) plus mitral valve surgery (MVS) in rheumatic populations (11,12 ). A multi-centre randomized controlled trial to provide predictive power of the resultant data is required for developing a surgical strategy for TA and MVS in rheumatic patients (10)(11)(12). Pacemaker implantation was not an issue in their series as well as Farooq and Bernal and their colleagues, but it is a global concern as indicated by a recent multicenter trial that TA carries an additional risk of pacemaker (PM) implantation at a rate of up to 14% as compared to 2.5% for mitral valve surgery alone (rate ratio, 5.75; 95% CI, 2.27 -14.60) (3,11,12).…”

“…Pacemaker implantation was not an issue in their series as well as Farooq and Bernal and their colleagues, but it is a global concern as indicated by a recent multicenter trial that TA carries an additional risk of pacemaker (PM) implantation at a rate of up to 14% as compared to 2.5% for mitral valve surgery alone (rate ratio, 5.75; 95% CI, 2.27 -14.60) (3,11,12). The risk for procedural related PM implantation needs to be addressed (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). It can be reduced or eliminated by refined TA techniques (2,3,(5)(6)(7)(8)(10)(11)(12).…”

“…The risk for procedural related PM implantation needs to be addressed (4)(5)(6)(7)(8)(9)(10)(11)(12)(13). It can be reduced or eliminated by refined TA techniques (2,3,(5)(6)(7)(8)(10)(11)(12).…”