Role of Tricuspid Valve Repair for Moderate Tricuspid Regurgitation during Minimally Invasive Mitral Valve Surgery

Abstract

IntroductionThe decision as to whether or not concomitant tricuspid valve (TV) surgery should be performed in patients with left-sided valve surgery was influenced for many years by an article from Braunwald et al in 1967. 1 In this article, the authors concluded that tricuspid regurgitation (TR), in the presence of concomitant mitral valve (MV), would "… improve or disappear after MV replacement and that TV replacement is seldom necessary."However, several publications in the past 10 years have demonstrated that up to 74% of patients undergoing successful left-sided valve surgery will develop TR over time with poor outcomes. [2][3][4][5] In addition, TV-related reoperation is associated with an early mortality rate ranging between 0 and 37%.

Tricuspid Annulus: A Three-Dimensional Deconstruction and Reconstruction

“…Hence, surgical therapy of mitral valve (MV) stenosis or regurgitation alone was believed to reduce upstream pressures with subsequent improvement in functional TR severity and right ventricular (RV) remodeling [3]. However, mild to moderate TR during MV surgery not only tends to recur postoperatively but is also associated with reduced functional recovery [6, 7]. As a result, there is a trend to treat mild to moderate TR during MV surgery with annuloplasty as an adjunct procedure, with improved functional recovery [3, 8].…”

Long-term outcomes of concomitant tricuspid valve repair in patients undergoing mitral valve surgery

“…Even with the longer procedural time, TVR performed at the time of MVS is generally a safe procedure [ 2 , 3 , 6 , 20 ]. We found no difference in procedure-related complications, and the only difference in 30-day complications was an increase in the need for PPI among patients who received the combined procedure.…”

Transcatheter tricuspid interventions: time to re-think guidelines?

“…Two main reasons are responsible for this undertreatment. The first is an obsolete belief that functional TR should improve or disappear after the primary left-sided problem treatment, which was refuted by well-conducted studies proving that TR remains or progresses after left-sided interventions [7]. The second is an unacceptable high morbimortality rate associated with conventional TR surgery, what, unfortunately, remains at least partially true, since TR carries the highest surgical mortality among all cardiac valve surgeries (8.8% -9.7%) [4].…”