To Do, or Not to Do: Tricuspid Valve Repair (In Functional Tr Secondary to Mitral Disease)

Abstract

Introduction: Functional TR has historically been left untreated based on the assumption that TR will improve if primary pathology is corrected. Data has suggested that this practice leads to poorer long-term outcomes. There is still ongoing debate over the optimal treatment of TR secondary to mitral valve disease. We at Dr. RMLHospital, New Delhi present our retrospective analysis of 140 patients undergoing MVR who had moderate or more TR, as well as a short review of literature on management of TR at the time of mitral valve replacement Methods:Aretrospective analysis of 140 consecutive patients who underwent MVR with moderate or more TR from 2018 to 2021. Patients were divided in 2 groups depending upon if they received primary TVr (treated group) or not (untreated group). At our centre, the need for tricuspid repair was guided by the severity of TR and tricuspid index. Patients requiring DVR or correction of other pathologies were excluded. Patients were followed-up on clinical assessment as well as echocardiography. Results: 92 patients were in group A and 48 in group B. There was no statistically signicant difference between the 2 groups in terms of demographics, length of hospital stay, need for inotropic support postoperatively. There was no perioperative mortality. 59 patients in group Ahad decreased TR on follow up whereas 30 had no change with only 3 having increased TR. In group B 15 had increased TR with no change in 31 with only 2 patients having decreased TR. Conclusion: Concomitant tricuspid valve repair with mitral valve surgery offers optimal long term results with acceptable short term morbidity and mortality and should be offered to patients with moderate or severe TR with tricuspid index >2.1 cm/m2