# Tricuspid annuloplasty in ischemic cardiomyopathy patients undergoing restrictive mitral annuloplasty

## TL;DR

Adding tricuspid annuloplasty during heart surgery for ischemic cardiomyopathy reduces tricuspid regurgitation without increasing risk or affecting survival.

## Contribution

Shows that tricuspid annuloplasty improves tricuspid regurgitation outcomes without increasing mortality in ischemic cardiomyopathy patients.

## Key findings

- Concomitant tricuspid annuloplasty reduced recurrence and progression of tricuspid regurgitation at 5 years.
- Tricuspid annuloplasty did not increase 30-day mortality despite higher surgical risk scores.
- Postoperative pulmonary hypertension severity was comparable between groups with or without tricuspid annuloplasty.

## Abstract

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).

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.

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).

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.