Impact of Tricuspid Regurgitation With and Without Repair During Aortic Valve Replacement

Abstract Background Long-term outcomes of aortic valve replacement (AVR) are worse in patients with tricuspid regurgitation (TR) but the impact of concomitant tricuspid valve intervention remains unclear. The purpose of this study was to determine the effect of tricuspid intervention in patients with TR undergoing AVR. Methods Patients undergoing AVR in a regional Society of Thoracic Surgeons database (2001-2017) were stratified by severity of TR and whether or not they underwent concomitant tricuspid intervention. Operative morbidity and mortality were compared among groups. Further analysis was performed using propensity score matched pairs. Results Among 17,483 patients undergoing AVR, 8,984 (51%) had no TR, 7,252 (41%) had mild, 1,060 (6%) had moderate, and 187 (1%) had severe tricuspid regurgitation. Overall, more severe regurgitation was associated with higher morbidity and mortality. Tricuspid intervention was performed in 104 (0.6%) patients, including 0.2% of patients with mild, 2% with moderate, and 31% with severe TR. In the propensity score matched analysis there was not a statistically significant difference in operative mortality (18% vs 9% p=0.16) but significantly higher composite major morbidity (51% vs 26% p=0.006) in the tricuspid intervention group compared to those without surgical TR correction. Conclusions Increasing severity of TR is associated with higher rates of morbidity and mortality after AVR. Correction of TR at the time of surgical AVR is not associated with increased operative mortality and has been shown to improve long-term outcomes.