Evaluation of preoperative and postoperative tricuspid valve functions in cases with and without simultaneous tricuspid valve intervention with mitral valve surgery

Objective: Tricuspid valve disease can be subclassified as regurgitation, stenosis, or a combination of both; it is most commonly the result of rheumatic fever. Functional tricuspid regurgitation is a condition that develops secondary to mitral and aortic valve diseases. The aim of this study is to investigate the changes in postoperative tricuspid valve functions in patients with preoperative moderate to advanced TR, who underwent mitral valve surgery and simultaneous tricuspid valve surgical intervention according to intraoperative tricuspid valve evaluation, and who did not. Thus, by comparing the decision made according to the preoperative evaluation and the intraoperative evaluation, to determine the best decision; however, it is aimed to increase the survival of the patients and to reduce the need for repeat surgery. Materials and Methods: The data of all patients who underwent mitral valve replacement at Akdeniz University Medical Faculty Hospital between 07.05.2014 and 25.10.2021 were analyzed retrospectively. To work; Patients with at least moderate additional tricuspid valve regurgitation who underwent mitral valve replacement due to isolated mitral stenosis, isolated mitral regurgitation and combined mitral stenosis and regurgitation were included. The patients included in the study were divided into two groups as those who did not intervene in the tricuspid valve concurrently with mitral valve replacement (MVR) and those who underwent simultaneous de Vega repair with mitral valve replacement (MVR+TDVA). A total of 89 patients were included in the study. Preoperative demographic data, functional status, cardiac rhythm, echocardiographic data and operational data of the patients were evaluated. Results: There were mostly female (68.5%) patients in the study and the mean age was 59.18±12.16 years. In addition to mitral valve replacement, Vega annuloplasty of the tricuspid valve was performed in 46 (51.6%) of the patients. Median weight and BMI values were significantly higher in the MVR+TDVA group than in the MVR group (p=0.002 and p=0.005). The rate of CAD in the MVR group (20.9%) was found to be significantly higher than in the MVR+TDVA group (2.2%) (p=0.006). Preoperative AF rate (89.1%) was found to be significantly higher in the MVR+TDVA group than in the MVR group (46.5%) (p<0.001). The mean HAIR of the MVR+TDVA group (5.17±0.69) was found to be significantly higher than the MVR group (4.76±0.62). The decrease in the degree of tricuspid regurgitation (-1 [IQR: -2-0]) was found to be significantly higher in patients in the MVR+TDVA group than in the MVR group (0 [IQR: -1-0]) (p=0.002). Conclusion: In our study, it was concluded that patients with moderate to severe ticuspid regurgitation in the preoperative evaluation and who underwent Vega annuloplasty according to the intraoperative tricuspid valve evaluation had a better level of reduction in tricuspid valve regurgitation than the patients who did not. Keywords: Tricuspid valve, mitral valve, de Vega, annuloplasty