Worsening tricuspid regurgitation after mitral valve surgery: a meta-analysis and meta-regression

Objectives: Reports of tricuspid valve regurgitation (TR) following mitral valve (MV) surgery are unclear. This study aims to estimate the prevalence of worsening TR (WTR) following MV surgery for non-rheumatic mitral regurgitation and the benefit of concomitant tricuspid annuloplasty. Methods: Electronic databases including Embase, PubMed, GoogleScholar, and Cochrane Library were searched between 2013 and 2024. A systematic review of the literature was conducted to include cohort studies, case-control studies and randomized-controlled trials. WTR was defined as ≥ moderate TR or an increase in TR severity of ≥2 grades on follow-up echocardiography. A random effects meta-analysis was performed. Subgroup analysis was conducted to estimate the benefit of a concomitant TV annuloplasty. A meta-regression was conducted to identify potential variables accounting for between-study heterogeneity. Sensitivity analyses were used to confirm the robustness of the reported results. Results: Of 8923 studies identified, 8 studies were included in the final analysis involving 2978 patients and 14,592 patient years (MV surgery-only group = 1991 patients, TV annuloplasty group = 987). WTR occurred in 9 % (95 %CI:4–22) of patients after MV surgery over a pooled follow-up of 4.9 [3.1–6.7] years. A concomitant TV annuloplasty resulted in a significant reduction in the prevalence of WTR (OR = 0.27, 95 %CI: 0.13–0.57, p = 0.0079). A trend for lower overall mortality was detected in the TV annuloplasty group (OR = 0.73, 95 %CI: 0.5–1.08). The pooled estimates were not significantly affected using a leave-one-out analysis meta-analysis. Conclusions: Despite surgical treatment of non-rheumatic mitral regurgitation, TR progresses in a considerable number of patients. Concomitant tricuspid annuloplasty significantly decreases the prevalence of WTR without affecting mortality.