The cumulative incidence of death at 7 years was 4.8% (1).
Progression of moderate TR from the baseline was similarly observed in
rheumatic and degenerative populations at a median follow-up of 53
months at 1, 5 and 7 years. It was 15.6% 33.8 and 39.3% in RHD group
and 16.1%, 30.4% and 36.02% in degenerative group, respectively. In
contrast to mitral valve repair vs replacement plus TA, progression of
moderate TR was less in the MV repair group (SHR: 1.69(1.03-2.78); P=
0.038). Results of the recently reported randomized controlled trial by
Gammie and colleagues showed much lesser progression of moderate TR at
two years (0.6% vs. 6.1% control group, relative risk, 0.09; 95% CI,
0.01 to 0.69) (1,10).
The authors should be congratulated for their laudable clinical
studies and for sharing the results with the global cardiovascular
community. Although it is a single centre observational trial, which
they admit, their data provide valuable information that stimulates
discussions in the clinical practice, which encourages early aggressive
approach for concomitant tricuspid annuloplasty (TA) plus mitral valve
surgery (MVS) in rheumatic populations. A multi-centre randomized
controlled trial to provide predictive power of the resultant data is
required for developing a surgical strategy for TA and MVS in rheumatic
patients (1,2,5,6,7). Pacemaker implantation was not an issue in their
series, but it is a global concern as indicated by a recent multicenter
trial that TA carries an additional risk of pacemaker (PM) implantation
at a rate of up to 14% as compared to 2.5% for mitral valve surgery
alone (rate ratio, 5.75; 95% CI, 2.27 - 14.60) (9). The risk for
procedural related PM implantation needs to be addressed. It
can be reduced or eliminated by refined TA techniques (9,10,11).