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Many patients undergoing mitral-valve surgery have associated tricuspid regurgitation (TR). Whether repair with tricuspid annuloplasty (TA) improves outcomes in patients with moderate or less-than-moderate TR with annular dilation at the time of mitral-valve surgery was investigated in this randomized trial (NCT02675244). Participants were 401 patients from 39 sites (mean age, 67 years; 25% women); mean annulus dimension was 42 mm, and moderate TR was present in 37%.
The primary endpoint of reoperation for TR, progression of TR by ≥2 grades or to severe TR, or death at 2 years occurred significantly less often with surgery plus TA (3.9%) than with surgery alone (10.2%; relative risk, 0.37). The difference was due to the progression of TR to severe (0.6% vs. 5.6%, respectively), which occurred primarily in those with moderate TR at baseline. Rates of mortality and other adverse events, including heart failure; quality of life; and rehospitalization frequency were similar in the groups. Permanent pacemakers were required more often in the TA patients (14% vs. 3%).
Gammie JS et al. Concomitant tricuspid repair in patients with degenerative mitral regurgitation. N Engl J Med 2021 Nov 13; [e-pub]. (https://doi.org/10.1056/NEJMoa2115961)
Comment
Although TA for moderate (or less-than-moderate) TR at the time of mitral-valve surgery reduced the progression to severe TR at 2 years in these patients, it also required more pacemaker implantations and did not improve quality of life or survival. Unfortunately, this mixed outcome does not clearly inform the decision on performing TA at the time of surgery, and longer-term follow-up will be needed to better understand its risks and benefits in this population.