An international study of more than 400 adults concludes that people who undergo mitral valve surgery (between the left atrium and the left ventricle of the heart) and also have less than severe leakage of the tricuspid valve (a section of the heart that directs blood from the right atrium to the ventricle) may benefit from having both valves repaired at the same time. The study found that simultaneous repair decreased the risk of future severe leakage of the tricuspid valve.
The results of the clinical trial were presented Nov. 13 at the American Heart Association’s annual Scientific Sessions meeting. The full study was published simultaneously in the New England Journal of Medicine.
Heart valves are responsible for regulating blood flow to and from the four chambers of the heart. The valves have leaflets, thin but strong flaps of tissue that work to keep blood from leaking back into the heart. When a valve leaks, it is known as regurgitation. Symptoms of such leaks include shortness of breath, fatigue and dizziness.
Leaky mitral valves are the most common type of heart valve abnormality, and are most often repaired or replaced by surgery. In the U.S., more than 50,000 operations are performed to fix mitral valve regurgitation annually.
To repair the tricuspid valve, a ring is implanted around the valve to treat and prevent progression of leaks and the fluid accumulation in the heart that is an independent risk factor for increased risk of death in the long term.
“There’s a general agreement among surgeons that if there is severe leakage of the tricuspid valve, then we should fix it,” said lead investigator James Gammie, M.D., surgical leader and co-director of the Heart and Vascular Institute at the Johns Hopkins University School of Medicine. “However, there has been considerable uncertainty as to whether the tricuspid valve needs repair at the time of mitral valve surgery when the leakage is only moderate or less.”
To study the potential effectiveness and safety of less than moderate tricuspid valve repair during mitral valve surgery, researchers conducted an international, multicenter, randomized controlled trial at 39 locations across the U.S., Canada and Germany between 2016 and 2018. A total of 401 adults were included in the study; 203 had only the mitral valve operation, while 198 had mitral valve surgery plus tricuspid valve repair. The participants were primarily white men (91% white; 75% male) and on average were 67 years old. Researchers assessed the rate of death, repeat operation for tricuspid regurgitation and progression of tricuspid valve leakage.
After a two-year follow-up of participants, the researchers found that overall, those who had both their mitral valve and their tricuspid valve problem repaired at the same time experienced better outcomes, such as less progression to moderate or severe leakage and improved treatment success than those who had only their mitral valve repaired.
