The prevalence, aetiologies, and clinical consequences of tricuspid regurgitation associated with severe degenerative mitral regurgitation

Aims: The prevalence, the aetiologies, and the clinical features of tricuspid regurgitation (TR) in the context of concomitant degenerative mitral valve (MV) disease are poorly defined. This paper aims to assess the prevalence, determinants, and clinical consequences of TR in severe degenerative mitral regurgitation (DMR).

Methods and results: Clinical and echocardiographic characteristics were collected among patients with severe DMR. A total of 884 patients were included in our study, 31% with ≥ moderate TR. Tricuspid valve prolapse (TVP) was the most common aetiology (487 patients, 55%), followed by atrial functional TR (AFTR, 172 patients, 19%) and ventricular functional TR (VFTR, 42 patients, 5%), while TR aetiology was classified as mixed in 183 (21%) patients. Patients with TVP were younger and had a better clinical presentation, few comorbidities, and less haemodynamically relevant TR. Patients with VFTR were characterized by older age, worse clinical presentation, and both highest comorbidity rate and prevalence of >mild TR. Patients with AFTR showed an intermediate profile of clinical presentation and comorbidities and the largest tricuspid annulus (TA) diameter. MV surgery was performed in 785 (88%) patients; 132 (15%) underwent simultaneous TV intervention, more often patients with AFTR (32%). TA dilatation [odds ratio (OR) 3.68, 95% confidence interval (CI) 2.05-6.62, P < 0.001] and >mild TR (OR 9.30, 95% CI 5.10-16.95, P < 0.001) were independently associated with TV intervention.

Conclusion: In patients with severe DMR, TR presents with different aetiologies, clinical features, and echocardiographic phenotypes that require a comprehensive assessment at the time of DMR surgery to ensure the best management for these patients.