Tricuspid intervention for less-than-severe regurgitation simultaneously with minimally invasive mitral valve surgery in patients with atrial fibrillation

BACKGROUND: While to address moderate tricuspid regurgitation (TR) at time of left-side heart surgery is recommended by the guidelines, the procedure is still seldom performed and especially in the minimally invasive setting. Atrial fibrillation (AF) is known marker of both mortality and TR progression after mitral valve surgery. AIMS: The current study aimed to address the safety of adding a tricuspid intervention to minimally invasive mitral valve surgery (MIMVS) in patients with preoperative AF. METHODS: We retrospectively analyzed data from Polish National Registry of Cardiac Surgery Procedures between 2006 and 2021. We included all patients who underwent MIMVS (mini-thoracotomy-, totally thoracoscopic- or robotic surgery) and presented with moderate tricuspid regurgitation and AF preoperatively. The primary endpoint was death from any cause at 30 days and at longest available follow between MIMVS with tricuspid intervention vs MIMVS alone. We used propensity score matching to account for baseline differences between groups. RESULTS: We identified 1,545 patients with AF undergoing MIMVS, 54.7% were men aged 66.7±9.2years. Of those, 733 (47.4%) underwent concomitant tricuspid valve intervention. At 13 years, addition of tricuspid intervention was associated with 33% higher mortality as compared to MIMVS alone. HR 1.33; 95 CIs (1.05-1.69); P=0.02. PS matching resulted in 565 well-balanced pairs. Concomitant tricuspid intervention did not influence long-term follow-up: HR, 1.01; 95 CIs (0.74-1.38); P=0.94. CONCLUSIONS: After adjusting for baseline cofounders the addition of tricuspid intervention for moderate tricuspid regurgitation to MIMVS did not increase perioperative mortality nor influence long-term survival.