title: Performing Concomitant Tricuspid Valve Repair at the Time of Mitral Valve Operations Is Not Associated With Increased Operative Mortality.
abstract: BACKGROUND
  The performance of concomitant tricuspid valve repair (TVr) at the time of mitral valve repair or replacement (MVRR) has previously been associated with elevated short-term risk. Outcomes were assessed at incremental grades of tricuspid regurgitation (TR) to quantify the contemporary risk of concomitant TVr.
  
  
  METHODS
  Between July 2011 and June 2014, 88,473 patients undergoing MVRR were examined using The Society of Thoracic Surgeons database. Outcomes with or without TVr, after isolated MVRR (n = 62,118) and MVRR with coronary artery bypass graft surgery (CABG [n = 26,355]), were independently analyzed at three levels of TR: none-mild, moderate, and severe. Risk-adjusted morbidity and mortality associated with the performance of concomitant TVr were evaluated using multivariable logistic regression.
  
  
  RESULTS
  The TR was graded as none-mild in 74.3% of patients (65,769 of 88,473), moderate in 17.2% (15,222 of 88,473), and severe in 8.5% (7,482 of 88,473). The rate of TVr by TR grade was 3.5% (2,308 of 65,769) for none-mild, 30.6% (4,661 of 15,222) for moderate, and 75.6% (5,654 of 7,482) for severe. Overall risk-adjusted occurrence of any morbidity associated with performance of TVr was increased in both groups (MVRR odds ratio [OR] 1.36, 95% confidence interval [CI]: 1.24 to 1.48; and MVRR plus CABG OR 1.33, 95% CI: 1.19 to 1.49). However, at all grades of TR, TVr was not associated with increased risk-adjusted mortality (MVRR OR 0.99, 95% CI: 0.84 to 1.17; and MVRR plus CABG OR 1.04, 95% CI: 0.85 to 1.27).
  
  
  CONCLUSIONS
  In contemporary patients, concomitant TVr is not associated with a risk-adjusted increase in mortality, regardless of TR severity. A more liberal approach to TVr at the time of MVRR may be justified when long-term benefits are thought to outweigh incremental short-term morbidity risk. Further investigation of longitudinal TVr outcomes is warranted.
authors: Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia. Electronic address: vinay.badhwar@wvumedicine.org.
authors: Vinay
authors: V
authors: Badhwar
authors: Division of Cardiothoracic Surgery, West Virginia University, Morgantown, West Virginia.
authors: J Scott
authors: JS
authors: Rankin
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Max
authors: M
authors: He
authors: Division of Cardiovascular Surgery, Johns Hopkins All Children's Heart Institute, All Children's Hospital, Johns Hopkins University School of Medicine, St. Petersburg, Florida, and Baltimore, Maryland.
authors: Jeffrey P
authors: JP
authors: Jacobs
authors: Starr-Wood Cardiac Group, Portland, Oregon.
authors: Anthony P
authors: AP
authors: Furnary
authors: Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
authors: Frank L
authors: FL
authors: Fazzalari
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Sean
authors: S
authors: O'Brien
authors: Division of Cardiac Surgery, University of Maryland, Baltimore, Maryland.
authors: James S
authors: JS
authors: Gammie
authors: Department of Surgery and Center for Quality and Safety, Massachusetts General Hospital, Boston, Massachusetts.
authors: David M
authors: DM
authors: Shahian
mesh_terms: D000368:Aged; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery*; D014481:United States / Q000453:epidemiology