Progression or persistence of tricuspid regurgitation after mitral valve replacement in patients with pre-operative moderate tricuspid regurgitation.

Purpose: There is a paucity of data on factors contributing to post-operative tricuspid regurgitation among patients with pre-operative moderate functional tricuspid regurgitation undergoing mitral valve replacement for rheumatic heart disease, the most common cause of mitral valve disease in the developing world.

Methods: Between January 2013 and December 2018, 476 patients underwent mitral valve replacement in our institution, of which 135 fulfilled the exclusion criteria. Of the remaining 341 patients, 142 had moderate functional tricuspid regurgitation. Our primary objective was to estimate the number of patients with of post-operative moderate to severe tricuspid regurgitation. Secondary outcomes were to determine the factors associated with it.

Results: Among the 142 patients who had pre-operative moderate functional tricuspid regurgitation (TR), mitral stenosis (46.4%) was the predominant lesion. Concomitant tricuspid annuloplasty (TAP) was done in 41 patients (28.9%). The median duration of follow-up was 35 (11, 79.5) months. Post-operative moderate to severe TR was recorded in 41.5%. Atrial fibrillation was significantly associated with post-operative moderate to severe TR (p = 0.006). Among the patients who did not undergo TAP, post-operative moderate to severe TR (85%, 50/59) compared to post-operative mild TR (61%, 51/83) with a p-value of 0.003.

Conclusion: Our data show that concomitant tricuspid annuloplasty during mitral valve replacement can be considered even in patients with pre-operative moderate TR and that pre-operative atrial fibrillation is significantly associated with post-operative TR.

Graphical abstract:

Supplementary information: The online version contains supplementary material available at 10.1007/s12055-025-01965-0.