Tricuspid annuloplasty in ischemic cardiomyopathy patients undergoing restrictive mitral annuloplasty.

Background: We elucidated the impact of concomitant tricuspid annuloplasty (TAP) on postoperative tricuspid regurgitation (TR), pulmonary hypertension (PH) and survival in patients with ischemic cardiomyopathy undergoing restrictive mitral annuloplasty (RMA).

Methods: This study included 234 patients with ischemic cardiomyopathy (LV ejection fraction ≤40%) who underwent RMA. Of them, 114 (49%) underwent concomitant TAP for secondary TR. The primary endpoint was freedom from significant recurrence (i.e., moderate or greater) and progression (≥2+ grades) in TR. The secondary endpoints were postoperative pulmonary artery systolic pressure (sPAP) and overall survival.

Results: The 30-day mortality was not different (0.9% vs. 0.8%, P = 0.97), despite higher EuroSCORE II score (median, 9.3% vs. 7.2%, P = 0.016) for TAP group. At baseline, TAP group had higher TR grades (2.4 ± 0.8 vs. 1.4 ± 0.6, P < 0.001) and sPAP (51 ± 16 vs. 44 ± 12 mmHg, P < 0.001). At 5-year post-surgery, RMA with TAP demonstrated higher freedom from recurrence or progression of TR (91 ± 3% vs. 81 ± 4%, log-rank P = 0.036), yielding nearly identical sPAP (42 ± 18 vs. 40 ± 16 mmHg, P = 0.54). Multivariable analysis demonstrated concomitant TAP was independently associated with freedom from significant recurrence in TR. Overall survival were not different between the groups (P = 0.74).

Conclusions: In patients with ischemic cardiomyopathy, concomitant TAP did not increase operative mortality and better reduced TR, resulting in comparable PH severity and long-term survival, compared to RMA alone.