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).