Impact of tricuspid valve regurgitation on intermediate outcomes of degenerative mitral valve surgery

Background: In patients undergoing mitral valve surgery, optimal management of less -than -severe concomitant tricuspid valve regurgitation (TR) is unclear, as there are few long-term data. This study examines progression of TR, patient survival, and reoperations in patients undergoing mitral valve surgery. Methods: There were 1588 patients who underwent degenerative mitral valve surgery and had pre- and postoperative echocardiograms for assessment of TR severity and tricuspid annulus diameter. Analysis used repeated -measures ordinal regression to model the longitudinal trends in TR grade and proportional hazards regression for long-term survival and reoperation outcomes. Results: Concomitant tricuspid valve (TV) surgery was performed in 235 (14.8 % ) patients. In response to surgery, TR grades improved more in patients with concomitant TV intervention regardless of the severity of preoperative TR, and these early trends were sustained over long-term follow-up. Risk of progression to severe TR was not in fl uenced by tricuspid annulus diameter ( P 1 / 4 .226). After we adjusted for underlying health characteristics, survival following mitral valve surgery was similar in patients with and without TV intervention. Late TV reoperation was observed in 22 patients (5 -year cumulative risk 1.5 % ), but among these, only 6 patients had severe TR as the primary indication for reoperation; preoperative TR grade and initial concomitant TV surgery were not associated with incidence of reoperation. Conclusions: Concomitant TV surgery for moderate TR reduces progression of TR but did not in fl uence survival or incidence of reoperation. Among patients with lessthan -severe preoperative TR, tricuspid annular diameter was not associated with progression to severe TR. (J Thorac Cardiovasc Surg 2024;167:2091-101)