An associated tricuspid annuloplasty during mitral valve replacement does not increase surgical risk and in-hospital morbidity and mortality: An observational study

Purpose To evaluate the impact of an associated tricuspid annuloplasty on surgical mortality and morbidity in patients who underwent mitral valve replacement. Methods The study was prospective observational. We included all consecutive patients undergoing mitral valve replacement for severe mitral stenosis or regurgitation on native valve, between January 2016 and December 2018. Tricuspid annuloplasty was performed according to European guidelines, based on severity of tricuspid regurgitation and tricuspid annulus size (superior to 40 mm). The primary end point included in-hospital mortality, major bleeding, pericardial effusion, tamponade and pace maker implantation. Results Three hundred forty two patients were enrolled, with a mean age of 60.8 ± 15.7 years and 57.3% of men. Seventy three percent of patients were in class NYHA II/III, 19.6% in class IV and 7.4% in class I. Indication for mitral valve replacement was mitral regurgitation in 59.4% of cases. The mean left ventricular ejection fraction was 48.1 ± 10.3%. Associated tricuspid annuloplasty was performed in 61.7% (n = 211) of the patients. The rates of in-hospital mortality were respectively 6.3% and 14.8% in patients with and without associated tricuspid annuloplasty (P = 0.01). Major bleeding was more frequent in patients with associated tricuspid annuloplasty (8.5% vs. 17.3%; P = 0.02). The incidence of pericardial effusion, tamponade and pace maker implantation was similar between the 2 groups. Conclusion Our data show that associated tricuspid annuloplasty in patients undergoing mitral valve replacement did not increase surgical risk and in-hospital mortality, supporting a wider use of this technique in such patients.