Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation
James S Gammie, Michael W A Chu, Volkmar Falk, Jessica R Overbey, Alan J Moskowitz, Marc Gillinov, Michael J Mack, Pierre Voisine, Markus Krane, Babatunde Yerokun, Michael E Bowdish, Lenard Conradi, Steven F Bolling, Marissa A Miller, Wendy C Taddei-Peters, Neal O Jeffries, Michael K Parides, Richard Weisel, Mariell Jessup, Eric A Rose, John C Mullen, Samantha Raymond, Ellen G Moquete, Karen O'Sullivan, Mary E Marks, Alexander Iribarne, Friedhelm Beyersdorf, Michael A Borger, Arnar Geirsson, Emilia Bagiella, Judy Hung, Annetine C Gelijns, Patrick T O'Gara, Gorav Ailawadi, CTSN Investigators
Abstract
Background: Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation.
Methods: We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death.
Results: Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P = 0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60).
Conclusions: Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up. (Funded by the National Heart, Lung, and Blood Institute and the German Center for Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.).
Copyright © 2021 Massachusetts Medical Society.
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Source: PubMed