title: Additional tricuspid annuloplasty in mitral valve surgery results in better clinical outcome.
abstract: OBJECTIVE
  The clinical benefit of tricuspid annuloplasty (TA) in patients undergoing mitral valve surgery (MVS) is still debated. We evaluated the immediate surgical success, postoperative outcome and the medium-term effect of TA in MVS.
  
  
  METHODS
  Patients were included between September 2003 and December 2009 and followed until September 2013 to achieve a median follow-up time of 5 years (IQR 3.7-6.9). The end point of mortality due to cardiac causes and combined end point of cardiac mortality or hospitalisation for heart failure were evaluated. Propensity score adjusted Cox regression was used to evaluate the clinical benefit of TA at the time of MVS.
  
  
  RESULTS
  Of 150 patients (84 female; 67±12 years), 82 presented with tricuspid regurgitation (TR) <2/4 and underwent isolated MVS. Of 68 patients presenting with TR≥2/4, 31 underwent isolated MVS whereas 37 underwent additional TA. In patients with preoperative TR≥2/4, TR was significantly reduced until 5 years postoperatively (mean reduction 0.81±1.31; p=0.04) when additional TA was done. The combined end point occurred in 29% vs 6% at 1 year and in 57% vs 39% at 5 years follow-up for patients with isolated MVS and patients undergoing concomitant TA, respectively. Patients with preoperative TR≥2/4 had worse unadjusted survival than those with TR<2/4 (logrank p=0.009). In the patients with TR≥2/4, propensity score-adjusted risk for the combined end point was higher in those with isolated MVS versus MVS with additional TA (Cox HR 2.855 (1.082-7.532), p=0.035).
  
  
  CONCLUSIONS
  Additional TA is an effective surgical measure to reduce functional TR severity. This approach results in a decreased risk of cardiac mortality and hospitalisation in patients with preoperative TR≥2/4.
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Pieter
authors.initials: P
authors.lastname: De Meester
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Dries
authors.initials: D
authors.lastname: De Cock
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Van De Bruaene
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Charlien
authors.initials: C
authors.lastname: Gabriels
authors.affiliation: Department of Rehabilitation Sciences, Catholic University of Leuven, Leuven, Belgium.
authors.forename: Roselien
authors.initials: R
authors.lastname: Buys
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Frederik
authors.initials: F
authors.lastname: Helsen
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Jens-Uwe
authors.initials: JU
authors.lastname: Voigt
authors.affiliation: Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Paul
authors.initials: P
authors.lastname: Herijgers
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Herregods
authors.affiliation: Department of Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
mesh_terms: D000368:Aged; D058385:Cardiac Valve Annuloplasty / Q000379:methods* / Q000401:mortality; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000401:mortality / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000401:mortality / Q000601:surgery*