November 19, 2021 11:16 AM

Addressing two leaky heart valves at once

Adding tricuspid repair to the OR docket makes sense for some patients already undergoing surgery for degenerative mitral regurgitation, a new study shows.

drawing in blue ink on notepad of a heart with lab note written bottom right in yellow and blue
Michigan Medicine

For some patients undergoing heart surgery to fix a leaky mitral valve, it might also be the right time to repair their moderately leaky tricuspid valve so it doesn’t become more severe and potentially require another operation.

That’s according to a new publication in the New England Journal of Medicine.

Researchers at 39 centers across the international Cardiothoracic Surgical Trials Network, including at University of Michigan Health, conducted a randomized clinical trial of 401 participants, monitoring them for two years after mitral valve surgery. Patients who had both mitral and tricuspid valves repaired during their trip to the operating room did not experience progression of tricuspid valve leakage later.

“In patients who are already undergoing degenerative mitral valve surgery, with moderate tricuspid regurgitation or less-than-moderate tricuspid regurgitation with a dilated tricuspid annulus, repairing the tricuspid valve with an annuloplasty decreases the risks of death, severe regurgitation or need for reoperation,” said study senior author Gorav Ailawadi, M.D., the chair of cardiac surgery at the U-M Health Frankel Cardiovascular Center. “Overall, this is a significant advancement in our understanding of tricuspid valve disease progression with long term follow-up planned for these patients.”

The patients’ quality of life and functional status after the two-year follow-up period were similar in both groups.

Ailawadi noted the downside to this combination approach was the increased risk of a patient requiring a pacemaker.

“Centers and surgeons should be aware of their own pacemaker risks in order to identify best practices to minimize this complication,” he said.

The investigators also noted a need for more diversity in future clinical trials, including efforts to understand the several-percentage-points difference between the true proportion of mitral valve patients who are Hispanic and/or Black and the proportion represented in this study.

Frankel CVC cardiac surgeons Steven Bolling, M.D., a professor of surgery, and Matthew Romano, M.D., an associate professor of surgery, also served as co-investigators on the trial. Lead author James Gammie, M.D., from the Johns Hopkins University School of Medicine, presented these results as a late-breaking trial during the American Heart Association’s 2021 Scientific Sessions meeting.

This content does not necessarily represent the views of project funders the National Heart, Lung, and Blood Institute of the National Institutes of Health, the U.S. Department of Health and Human Services, or the German Center for Cardiovascular Research.

Paper cited: “Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation,” The New England Journal of Medicine. DOI: 10.1056/NEJMoa2115961