MP28. Is Tricuspid Annuloplasty Falling out of Favor During Mitral Surgery?
Presented During: Moderated E-Posters
CHARLOTTESVILLE, VA
United States - Contact Me
Dr. Alex Wisniewski is a native of Toledo, OH and is currently an integrated cardiothoracic surgery resident at the University of Virginia. His career interests lie in adult cardiac surgery upon completion of his training. Outside of residency, he hikes frequently around the Blue Ridge mountains in Virginia and travels out west for different snowboarding adventures.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: Concomitant repair of the tricuspid valve during surgery for degenerative mitral regurgitation remains contentious. Current guidelines recommend intervention when at least moderate regurgitation or excessive annular dilation is present. A recent CTSNet trial did not demonstrate a mortality benefit or improvement in quality of life following concomitant repair but did demonstrate significantly higher permanent pacemaker placement. We sought to quantify the rate of tricuspid repair in eligible patients following publication of these trial results.
Methods: Utilizing a regional collaborative, we identified all patients from 2017 until present with degenerative mitral regurgitation undergoing mitral valve repair or replacement. We included only those patients with moderate tricuspid regurgitation or annular diameter greater than 40 millimeters. Those with endocarditis, primary tricuspid regurgitation, severe tricuspid regurgitation, or undocumented degree of tricuspid disease were excluded. Our time event was February 22, 2022 when the trial results were published. A 1-month washout period before and after time of publication was employed to account for change in surgeon practice.
Results: We identified 164 patients who met inclusion criteria with 17 (10.4%) patients undergoing surgery in the post-trial period. The rate of tricuspid annuloplasty in the pre-trial group was 45.6% as compared to 35.3% in the post-trial group (p=0.42). Baseline demographics and comorbidities between the groups were similar. All postoperative outcomes including mortality were similar between the groups (p>0.05) aside from a higher rate of reoperation for valve dysfunction in the post-trial group (5.88% vs. 0.00%, p=0.003).
Conclusion: Despite similar degrees of indication for tricuspid intervention, there appears to be a slow downtrend, although non-significant, in the rate of tricuspid annuloplasty during mitral surgery following trial publication. Longer term data is necessary to elucidate future trends in concomitant tricuspid annuloplasty.
Methods: Utilizing a regional collaborative, we identified all patients from 2017 until present with degenerative mitral regurgitation undergoing mitral valve repair or replacement. We included only those patients with moderate tricuspid regurgitation or annular diameter greater than 40 millimeters. Those with endocarditis, primary tricuspid regurgitation, severe tricuspid regurgitation, or undocumented degree of tricuspid disease were excluded. Our time event was February 22, 2022 when the trial results were published. A 1-month washout period before and after time of publication was employed to account for change in surgeon practice.
Results: We identified 164 patients who met inclusion criteria with 17 (10.4%) patients undergoing surgery in the post-trial period. The rate of tricuspid annuloplasty in the pre-trial group was 45.6% as compared to 35.3% in the post-trial group (p=0.42). Baseline demographics and comorbidities between the groups were similar. All postoperative outcomes including mortality were similar between the groups (p>0.05) aside from a higher rate of reoperation for valve dysfunction in the post-trial group (5.88% vs. 0.00%, p=0.003).
Conclusion: Despite similar degrees of indication for tricuspid intervention, there appears to be a slow downtrend, although non-significant, in the rate of tricuspid annuloplasty during mitral surgery following trial publication. Longer term data is necessary to elucidate future trends in concomitant tricuspid annuloplasty.