JUAN CRESTANELLO: Welcome to the Cardiovascular Surgery Series where a review of the latest research in cardiovascular surgery. I am Dr. Juan Crestanello. I am a cardiac surgeon at the Mayo Clinic in Rochester, Minnesota. Today, I will review the multicenter trial by the Cardiothoracic Surgery Trials Network.
The title of the trial is "Concomitant tricuspid repair in patients with degenerative mitral regurgitation." In this trial, Gammie and associates reported that the addition of tricuspid angioplasty to patients with moderate or less tricuspid regurgitation during mitral valve surgery reduced the rate of progression to severe TR from 6.1% in the mitral surgery alone group to 0.6% in the combined group. These results should be interpreted in the context of the two populations of patients included in the trial. One group where the patients with tricuspid annular dilatation and less than moderate tricuspid regurgitation. The second group were the patients with moderate tricuspid regurgitation.
Patients with tricuspid annular dilatation and less than moderate tricuspid regurgitation at baseline constituted more than 60% of the trial population. In this group, TR progression was not observed in any of them, with or without tricuspid annuloplasty. Progression of TR was only seen in the patients with moderate tricuspid regurgitation at baseline. While tricuspid annuloplasty had no effect on TR progression in the group with tricuspid annular dilatation and less than moderate TR, it effectively reduced tricuspid regurgitation progression in those with moderate tricuspid regurgitation.
We conclude that the contribution of tricuspid annuloplasty in reducing tricuspid regurgitation progression was diminished, given the differences in population size and in the natural history of untreated TR between the two groups. Consequently, pending further follow-up, we believe that tricuspid annuloplasty is not indicated for patients with tricuspid annular dilatation and less than moderate TR, particularly in view of the increased need for permanent pacemaker among those patients. Thank you for listening to the Mayo Clinic Cardiovascular Surgery Series.
