Comparison of Mitral Valve Repair versus Replacement for the Progression of Functional Tricuspid Regurgitation

Abstract

Background: Function tricuspid regurgitation (TR) is frequently observed in patients undergoing mitral valve surgery. It is unclear that mitral valve repair (MVr) or mitral valve replacement (MVR) has influence on the likelihood of late TR progression. Methods: This study included 193 patients with degenerative mitral valve disease who underwent either MVr or MVR. Detailed preoperative materials, follow-up information, and echocardiographic data were collected and statistically analyzed. Results: At 6 and 12 months postoperatively, MVR patients were more likely to have New York Heart Association (NYHA) class III or IV symptoms than MVr patients (6 mo: 15.2% vs 5.0%, 12 mo: 13.0% vs 4.0%, both P <0.05). At 24 months, the incidence of Grade 1+ TR was significantly higher in MVR patients than MVr patients (25.0% vs 12.9%, P <0.05). In univariate analysis, age (odds ratio [OR] = 1.036, P = 0.036), MVR (OR = 2.256, P = 0.033), and preoperative TR area (TRA; OR = 1.541, P = 0.047) were significant predictors for TR progression. In multivariate logistics analysis, only MVR was independently risk factor (P = 0.006). Subsequently, patients were divided into tricuspid valve repair (TVr) group and untreated group. In both subgroups, MVR patients were associated with significantly larger TRA (P <0.01). Conclusion: MVR was an independent risk factor for TR progression, whether tricuspid valve was treated or not.

Establishment and Validation of a Predictive Model for Long-Term Severe Functional Tricuspid Regurgitation after Mitral Valve Replacement

“…These indicators were then subject to multivariate analysis, where age, gender, LAD, AF, PH, and TRA are found to be independent risk factors affecting long-term S-FTR likelihood in MVR patients. Their correlation with S-FTR was supported by previous studies demonstrating close associations between LAD, PH, AF, and TRA with post-mitral valve surgery FTR [Gao 2020;Mutlak 2020;Choi 2018;Bertrand 2021], owing to long-term mitral valve diseases causing left atrial expansion, atrial muscle remodeling, plus AF-causing cardiomyocyte electrophysiological and mechanical changes [Beckhoff 2018]. Sustained AF, in turn, causes atrial mechanical activity loss, resulting in various pathological processes, including hemodynamic changes, further left atrial expansion, PH from vasoconstriction and remodeling, irreversible RV myocardial damage, and gradual TA increase.…”

“…It is classified into primary and secondary types, where the former results from inherent valvular disease, while the latter does not involve any valvular abnormalities. Secondary, also known as functional TR (STR/FTR), is a common occurrence post mitral valve replacement (MVR) surgery of rheumatic heart disease (RHD), and often is aggravated post-operation, leading to irreversible RV dysfunction, heart failure, and death [Topolsky 2019;Gao 2020;Wang 2019]. As a result, the 2020 American Heart Association/American College of Cardiology guidelines recommend severe FTR (S-FTR) patients to simultaneously undergo MVR and tricuspid valve (TV) surgery.…”

The influence of mitral valve pathology on the concomitant tricuspid valve repair

“…The effect of MV surgery on the progression of TR is inconsistent in the literature. 26 Gao et al 27 found that MV replacement was an independent predictor of recurrent TR in patients with degenerative etiology. 27 Literature comparing the effect of mitral surgery on TR in different MV pathologies is limited.…”

“…26 Gao et al 27 found that MV replacement was an independent predictor of recurrent TR in patients with degenerative etiology. 27 Literature comparing the effect of mitral surgery on TR in different MV pathologies is limited. Our results could support the hypothesis that MV surgery did not affect TR progression in rheumatic and degenerative etiologies.…”

Association Between Functional Tricuspid Regurgitation and Mortality Following Cardiac Surgery

“…Moreover, it is reassuring to note that progression of untreated non-severe TR is far less common (<5%-10% of cases) than stability or regression after aortic or mitral valve surgery. 31 , 32 …”