Whether to perform concomitant tricuspid repair in patients undergoing cardiac surgery for degenerative mitral regurgitation is a question that has been raised since the beginning of multivalve surgery. In the United States, there is a wide range in terms of what is performed in practice (<5% to >75% perform concomitant tricuspid surgery).^1-3 Gammie et al. recently reported in a multicenter trial with 401 randomized patients with moderate tricuspid regurgitation or annular dilation (≥40mm) undergoing mitral surgery that the primary endpoint of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation (by two grades or severe regurgitation), or death was less often met in the concomitant valve surgery versus mitral valve surgery alone group (3.9% vs. 10.2%, P=0.02).^1,2 Of note, the primary end-point occurred at 2 years and the multivalve surgery group had higher permanent pacemaker implantation (14.1% vs. 2.5%, rate ratio 5.75).^1,2

References

1. Gammie JS, Chu MWA, Falk V, et al. Concomitant tricuspid repair in patients with degenerative mitral regurgitation. N Engl J Med 2021;Nov 13:[Epub ahead of print].
2. Chikwe J, Gaudino M. The price of freedom from tricuspid regurgitation. N Engl J Med 2021;Nov 13:[Epub ahead of print].
3. Badhwar V, Rankin JS, He M, et al. Performing concomitant tricuspid valve repair at the time of mitral valve operations is not associated with increased operative mortality. Ann Thorac Surg 2017;103:587-93.

Clinical Topics: Arrhythmias and Clinical EP, Cardiovascular Care Team, Valvular Heart Disease, Implantable Devices, SCD/Ventricular Arrhythmias, Atrial Fibrillation/Supraventricular Arrhythmias, Mitral Regurgitation, Cardiac Surgery

Keywords: AHA Annual Scientific Sessions, AHA21, American Heart Association, Tricuspid Valve Insufficiency, Tricuspid Valve, Mitral Valve, Mitral Valve Insufficiency, Reoperation, Dilatation, Life Expectancy, Morbidity, Arrhythmias, Cardiac, Pacemaker, Artificial, Fibrinogen

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