Long-term outcomes of concomitant suture bicuspidization technique to treat mild or moderate tricuspid regurgitation in patients undergoing mitral valve surgery

Objectives: The aim of this study was to investigate the long-term outcomes of concomitant suture bicuspidization to treat mild or moderate tricuspid regurgitation at the time of mitral valve (MV) surgery. Methods: Data from patients who underwent MV surgery for degenerative MV regurgitation with mild or moderate tricuspid regurgitation and annular dilatation between January 2009 and December 2017 were analysed. The cohort was divided into 2 groups: mitral valve surgery alone (MVA) and MV surgery with concomitant tricuspid valve (TV) repair. Results: A total of 196 patients were included in the study. MVA and MV surgery with concomitant TV repair were performed in 91 (46.4%) and 105 (53.6%) patients, respectively. Propensity score matching analysis identified 54 pairs. In the matched cohort, 30-day mortality (0.0% vs 1.9%, P = 1.0) and new permanent pacemaker implantation (11.1% vs 7.4%, P = 0.740) did not differ significantly between groups. After a mean follow-up of 6.0 (2.8) years, MV surgery with concomitant TV repair was not associated with increased mortality risk compared to MVA (hazard ratio 1.04, 95% confidence interval 0.47-2.28, P = 0.927) with 10-year overall survival rates of 69.9% and 77.2%, respectively. Furthermore, MV surgery with concomitant TV repair was associated with a significantly reduced progression of TV regurgitation (P < 0.001). Conclusions: Patients undergoing MV surgery with concomitant TV repair had similar 30-day and long-term survival, similar permanent pacemaker implantation rate and reduced progression of TV regurgitation compared to those undergoing MVA.