Rohit Rajput - Section Editor Surgical Department
DOI: 10.1056/NEJMoa2115961
In “Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation” by J.S. Gammie et al., the researchers observed that patients with degenerative mitral regurgitation also commonly have some level of tricuspid regurgitation-the mitral and tricuspid valves are the primary valves between the chambers of the heart. More specifically, how would treatment outcomes differ if a patient undergoing mitral valve repair surgery also had their tricuspid valve repaired in the same procedure. To build an evidence base to better inform deliberating surgeons, patients undergoing mitral valve repair were randomly assigned to have their procedure with or without tricuspid repair concurrently. A metric titled primary-end-point events measured outcomes two years post surgery between the two groups and included “reoperation for tricuspid regurgitation, progression of tricuspid regurgitation by two grades from baseline or the presence of severe tricuspid regurgitation, or death.” The results showed less primary-end-point events in those who underwent mitral and tricuspid valve repair together since there less frequent progression of severe tricuspid regurgitation compared to those who underwent mitral-repair alone.
Although some may see surgery as a fixed procedure with a predetermined list of steps for a patient’s problem, in reality it is much more. Using thorough understanding of the human anatomy alongside critical thinking skills, surgeons are actually quite dynamic in their work and tailor procedures individually for each patient’s best outcomes. Noticing that one anatomical problem is usually accompanied by another (mitral with tricuspid valve failure) and repairing them together provides better outcomes without another invasive procedure for the patient. This is what separates a good surgeon from a great surgeon! Medicine isn’t just about solving the problem at hand while other factors in the patient’s health worsens; research like this looks for lasting solutions integrating proactivity/prevention as a cornerstone in healthcare.
Bibliography:
Gammie, J. S., Chu, M. W. A., Falk, V., Overbey, J. R., Moskowitz, A. J., Gillinov, M., Mack, M. J., Voisine, P., Krane, M., Yerokun, B., Bowdish, M. E., Conradi, L., Bolling, S. F., Miller, M. A., Taddei-Peters, W. C., Jeffries, N. O., Parides, M. K., Weisel, R., Jessup, M., Rose, E. A., … CTSN Investigators (2022). Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation. The New England journal of medicine, 386(4), 327–339. https://doi.org/10.1056/NEJMoa2115961
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