Long-Term Tricuspid Regurgitation Progression in Patients Undergoing Combined Mitral Valve Replacement Surgery and Tricuspid Valve Repair

Background: Current guidelines recommend combined tricuspid valve surgery in patients undergoing mitral valve replacement (MVR) presenting with either moderate or severe tricuspid regurgitation (TR) or with dilated tricuspid annulus (≥4 cm). Limited evidence is available regarding the long-term TR progression in patients undergoing the combined procedure.

Aims: To compare echocardiographic outcomes among patients with rheumatic mitral valve disease undergoing MVR surgery with or without tricuspid valve repair.

Methods: Single center retrospective study of mitral valve surgery cohort in a tertiary hospital. Following exclusion of patients undergoing tricuspid valve replacement, our final cohort included 323 patients with rheumatic mitral valve disease undergoing MVR surgery; either isolated MVR surgery (iMVR group- 233 patients, 72% of cohort) or MVR combined with tricuspid valve repair (cTVr group- 90 patients, 28% of cohort). TR severity grade was assessed according to current echocardiography guidelines and graded using a 0-3 scale (none/trivial, mild, moderate, severe).

Results: In comparison to the iMVR group, pre-surgery echocardiographic findings in the cTVr group demonstrated higher mean TR severity grade (1.22 versus 2.03, respectively, p<0.0001) and higher mean pulmonary hypertension (45 and 54 mmHg, respectively, p<0.020). Long-term echocardiography parameters (median 1752 days, IQR 1484, 3126) demonstrated that 72% of patients in the cTVr group regressed their TR severity grade compared to 28% of patients in the iMVR group (<0.0001). Moreover, 6.5% of patients in the cTVR group compared to 28% of patients in the iMVR group increased their TR severity grade (p=0.02).

Conclusion: The addition of TVr during MVR for rheumatic heart disease was associated with a significant decrease of late TR.