Performing tricuspid valve (TV) annuloplasty during mitral valve (MV) surgery can improve long-term outcomes for some patients with primary mitral regurgitation (MR), according to new findings published in the American Journal of Cardiology.
“Current guidelines recommend concomitant TV annuloplasty at the time of left-sided valve surgery in patients with a dilated TV annulus of more than 40 mm independent of the presence or severity of tricuspid regurgitation (TR),” wrote first author Marlieke F. Dietz, MD, of Leiden University Medical Center in the Netherlands, and colleagues. “Although various studies have confirmed reduction of TR after this procedure, the long-term impact on right ventricular (RV) adverse remodeling and clinical outcomes is less well established and the benefit of preventive TV annuloplasty remains controversial.”
Dietz et al. examined data from 98 patients who underwent MV repair for significant primary MR at a single facility in the Netherlands from 2000 to 2017. The mean patient age was 65 years old, and 85% of patients were men. All patients presented with TV annulus dilatation of more than 40 mm. They did not have significant TR at the time of the procedure. Also, 55% of patients presented with atrial fibrillation—many of them underwent a maze procedure during treatment to address that issue.
Of those 98 patients, 70 underwent TV annuloplasty. Overall, the authors found, both groups saw significant reductions in MR severity and left atrial size.
TV annuloplasty during MV surgery was associated with lowering the risk of RV remodeling. TV annuloplasty did not appear to impact RV function in any way.
Also, while four patients who did not undergo TV annuloplasty went on to develop significant TR, no patients who underwent TV annuloplasty developed significant TR.
During a median follow-up period of 6.4 years, the group added, nine patients from the TV annuloplasty group and seven patients from the no TV annuloplasty group died. A more thorough analysis “showed no significant differences in survival rates” between the two patient groups.
“The most frequent adverse events during follow-up were the need of a pacemaker or implantable cardioverter-defibrillator and new onset AFib,” the authors added. “No significant differences in incidence of these or other outcomes between patients with versus without TV annuloplasty were observed.”
While this was a single-center analysis, the authors said their findings “underscore that preventive TV annuloplasty may be effective in reducing the late development of TR and RV dilatation.”
“Larger randomized controlled trials with long-term follow-up are needed to provide further insight whether the preventive TV annuloplasty approach is associated with improved clinical outcomes,” the group wrote.
Read the full analysis here.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.