Clinical and hemodynamic influences of prophylactic tricuspid annuloplasty in mechanical mitral valve replacement

Abstract

Prophylactic TAP for patients with less-than-moderate TR grade who underwent mechanical MVR can prevent late TR progression without increasing early surgical risks. Longer-term follow-up is required to determine the clinical beneficial effect of prophylactic TAP.

How much is enough to warrant prophylactic tricuspid repair?

“…To balance this increased risk it is important to determine the potential benefit; however, Rajbanshi and colleagues 3 report minimal progression of TR after MVR or MVR in a large cohort of patients with preoperative moderate or less TR. Lee and colleagues 1 present the long-term benefit of prophylactic TAP for patients with moderate or less TR as a major finding with similar short-term adverse events between the TAP and no-TAP groups.…”

“…In conclusion, the study by Lee and colleagues 1 is an interesting retrospective analysis of the effect of TAP at the time of MVR with mechanical heart valves. Unfortunately this study raises numerous questions that cannot be adequately answered by propensity matching.…”

“…For this reason it is critical to identify patients who will benefit from TAP to ameliorate long-term tricuspid valve-related events such as reoperation for TR, right heart failure, and pacemaker insertion. Lee and colleagues 1 do not address this specific issue.…”

“…We congratulate Lee and colleagues 1 on an interesting and thoughtful article that makes several controversial points. There is no dispute about tricuspid valve annulopasty (TAP) during mitral valve replacement (MVR) in patients with severe tricuspid regurgitation (TR), but the proposition of performing a concomitant procedure in a prophylactic setting raises safety concerns.…”

Clinical Implication of Transaortic Mitral Pannus Removal During Repeat Cardiac Surgery for Patients With Mechanical Mitral Valve

“…trend in prophylactic tricuspid annuloplasty to prevent reoperation will be the most important issue in left-sided valve surgery for patients with rheumatic and degenerative diseases. 14- 17 Some studies have reported that mitral prosthesispatient mismatch (PPM) is independently associated with increased mortality, 18,19 but another study found no significant effect on survival. 20 Angeloni et al showed that mitral PPM is associated with the persistence of functional TR and pulmonary hypertension after MVR.…”