Our Summary

This research paper looks at the controversy around the management of certain heart valve problems, specifically tricuspid regurgitation (when the tricuspid valve doesn’t close tightly and blood leaks backward in the heart) and annular dilation (widening of the valve opening) during mitral valve repair.

Recent findings show that if tricuspid regurgitation is moderate, fixing it at the same time as the mitral valve can be effective in reducing the progression of the problem for up to 2 years. However, this doesn’t seem to improve survival rates, quality of life, or function in the long run, and it does increase the rate of people needing a permanent pacemaker, which is linked with lower survival rates.

If tricuspid regurgitation is less than moderate and there’s only annular dilation, it’s rare for the problem to get worse, so there seems to be no need to do a concomitant repair.

In simple terms, fixing tricuspid regurgitation at the same time as the mitral valve can slow down the problem for a while, but it doesn’t improve the long-term outcome and might lead to more pacemakers being needed. If the tricuspid regurgitation is not too severe and the valve opening is just widened, it might not be necessary to fix it at all. More research is needed to give a clearer picture on this issue.

FAQs

  1. What is the current controversy surrounding the management of tricuspid regurgitation and annular dilation during mitral valve repair?
  2. What are the potential complications of concomitant tricuspid valve repair during mitral valve repair?
  3. How effective is repairing less than moderate tricuspid regurgitation for annular dilation alone, and how does this impact current guideline recommendations?

Doctor’s Tip

A helpful tip a doctor might tell a patient about mitral valve repair is to carefully weigh the benefits and risks of repairing concomitant moderate tricuspid regurgitation during the procedure. While it can reduce tricuspid regurgitation progression at 2 years, it may also increase the risk of needing a permanent pacemaker implantation. It is important to discuss these considerations with your healthcare provider to make the best decision for your individual situation.

Suitable For

Patients who are typically recommended for mitral valve repair include those with severe mitral regurgitation or mitral stenosis, as well as those with structural abnormalities of the mitral valve such as prolapse or flail leaflets. Patients with symptoms such as shortness of breath, fatigue, chest pain, or palpitations may also be recommended for mitral valve repair. Additionally, patients who are at high risk for complications from mitral valve replacement surgery may be recommended for mitral valve repair instead.

Timeline

Before mitral valve repair:

  • Patients may experience symptoms such as shortness of breath, fatigue, and chest pain due to mitral valve regurgitation or stenosis.
  • Patients undergo diagnostic tests such as echocardiograms, MRI, and cardiac catheterization to assess the severity of the mitral valve disease.
  • Depending on the severity of the disease, patients may be recommended for mitral valve repair surgery.

After mitral valve repair:

  • Patients undergo mitral valve repair surgery, which may involve repairing or replacing the mitral valve to improve its function.
  • Following surgery, patients are monitored closely in the hospital for any complications and to ensure proper healing.
  • Patients undergo cardiac rehabilitation to help them recover and regain strength.
  • Over time, patients may experience improvements in symptoms such as reduced shortness of breath and fatigue, and improved quality of life.

What to Ask Your Doctor

  1. What is the current level of tricuspid regurgitation and annular dilation, and what are the risks and benefits of repairing it during mitral valve repair?
  2. What are the potential long-term effects of not repairing the tricuspid valve during mitral valve repair?
  3. What factors should be considered in deciding whether to repair the tricuspid valve during mitral valve repair?
  4. What are the potential complications associated with repairing the tricuspid valve during mitral valve repair, such as permanent pacemaker implantation?
  5. What is the success rate of repairing the tricuspid valve during mitral valve repair, and what is the expected outcome in terms of quality of life and functional benefit?
  6. What are the guidelines and recommendations regarding repairing the tricuspid valve during mitral valve repair, and how do they apply to my specific case?
  7. What is the follow-up plan after undergoing mitral valve repair with or without tricuspid valve repair, and what symptoms should I watch out for that may indicate a complication?

Reference

Authors: An KR, Nwajei E, Chu MWA. Journal: Curr Opin Cardiol. 2025 Mar 1;40(2):85-90. doi: 10.1097/HCO.0000000000001193. Epub 2024 Dec 11. PMID: 39749816