Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation.

Gammie, James S; Chu, Michael W A; Falk, Volkmar; Overbey, Jessica R; Moskowitz, Alan J; Gillinov, Marc; Mack, Michael J; Voisine, Pierre; Krane, Markus; Yerokun, Babatunde; Bowdish, Michael E; Conradi, Lenard; Bolling, Steven F; Miller, Marissa A; Taddei-Peters, Wendy C; Jeffries, Neal O; Parides, Michael K; Weisel, Richard; Jessup, Mariell; Rose, Eric A; Mullen, John C; Raymond, Samantha; Moquete, Ellen G; O'Sullivan, Karen; Marks, Mary E; Iribarne, Alexander; Beyersdorf, Friedhelm; Borger, Michael A; Geirsson, Arnar; Bagiella, Emilia; Hung, Judy; Gelijns, Annetine C; O'Gara, Patrick T; Ailawadi, Gorav     «

Gammie, James S; Chu, Michael W A; Falk, Volkmar; Overbey, Jessica R; Moskowitz, Alan J; Gillinov, Marc; Mack, Michael J; Voisine, Pierre; Krane, Markus; Yerokun, Babatunde; Bowdish, Michael E; Conradi, Lenard; Bolling, Steven F; Miller, Marissa A; Taddei-Peters, Wendy C; Jeffries, Neal O; Parides, Michael K; Weisel, Richard; Jessup, Mariell; Rose, Eric A; Mullen, John C; Raymond, Samantha; Moquete, Ellen G; O'Sullivan, Karen; Marks, Mary E; Iribarne, Alexander; Beyersdorf, Friedhelm; Borger, Mi...     »

BACKGROUND: Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation. METHODS: We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a procedure with or without tricuspid annuloplasty (TA). The primary 2-year end point was a composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death. RESULTS: Patients who underwent mitral-valve surgery plus TA had fewer primary-end-point events than those who underwent mitral-valve surgery alone (3.9% vs. 10.2%) (relative risk, 0.37; 95% confidence interval [CI], 0.16 to 0.86; P = 0.02). Two-year mortality was 3.2% in the surgery-plus-TA group and 4.5% in the surgery-alone group (relative risk, 0.69; 95% CI, 0.25 to 1.88). The 2-year prevalence of progression of tricuspid regurgitation was lower in the surgery-plus-TA group than in the surgery-alone group (0.6% vs. 6.1%; relative risk, 0.09; 95% CI, 0.01 to 0.69). The frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar in the two groups at 2 years, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group than in the surgery-alone group (14.1% vs. 2.5%; rate ratio, 5.75; 95% CI, 2.27 to 14.60). CONCLUSIONS: Among patients undergoing mitral-valve surgery, those who also received TA had a lower incidence of a primary-end-point event than those who underwent mitral-valve surgery alone at 2 years, a reduction that was driven by less frequent progression to severe tricuspid regurgitation. Tricuspid repair resulted in more frequent permanent pacemaker implantation. Whether reduced progression of tricuspid regurgitation results in long-term clinical benefit can be determined only with longer follow-up. (Funded by the National Heart, Lung, and Blood Institute and the German Center for Cardiovascular Research; ClinicalTrials.gov number, NCT02675244.).      «

BACKGROUND: Tricuspid regurgitation is common in patients with severe degenerative mitral regurgitation. However, the evidence base is insufficient to inform a decision about whether to perform tricuspid-valve repair during mitral-valve surgery in patients who have moderate tricuspid regurgitation or less-than-moderate regurgitation with annular dilatation. METHODS: We randomly assigned 401 patients who were undergoing mitral-valve surgery for degenerative mitral regurgitation to receive a proce...     »