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AHA: Risk-Benefit of Mitral Valve Surgery Plus Tricuspid Annuloplasty Studied

For mitral valve surgery plus TA, risk for primary end-point event lower at two years, but risk for permanent pacemaker implantation higher

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FRIDAY, Nov. 19, 2021 (HealthDay News) -- For patients undergoing surgery for degenerative mitral regurgitation who have moderate or less-than-moderate tricuspid regurgitation, those who also undergo tricuspid annuloplasty (TA) are less likely to have progression to severe tricuspid regurgitation, but are more likely to require permanent pacemaker implantation, according to a study published online Nov. 13 in the New England Journal of Medicine to coincide with the American Heart Association Scientific Sessions 2021, held virtually from Nov. 13 to 15.

James S. Gammie, M.D., from Johns Hopkins School of Medicine in Baltimore, and colleagues randomly assigned 401 patients who were undergoing mitral valve surgery for degenerative mitral regurgitation to receive surgery with or without TA.

The researchers observed fewer primary end-point events (composite of reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death) for patients who underwent surgery plus TA compared with those who underwent surgery alone (3.9 versus 10.2 percent; relative risk, 0.37). Two-year mortality did not differ significantly between the groups (3.2 and 4.5 percent, respectively). The surgery-plus-TA group had a lower two-year prevalence of progression of tricuspid regurgitation (0.6 versus 6.1 percent; relative risk, 0.09). At two years, the frequencies of major adverse cardiac and cerebrovascular events, functional status, and quality of life were similar between the groups, although the incidence of permanent pacemaker implantation was higher in the surgery-plus-TA group (14.1 versus 2.5 percent; rate ratio, 5.75).

"This trial and others will support a larger body of research that surgeons, professional societies, and medical organizations can use as they update surgical treatment guidelines in the future," a coauthor said in a statement.

Several authors disclosed financial ties to the biopharmaceutical and medical device industries.

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