279 * PROPHYLACTIC TRICUSPID ANNULOPLASTY IN PATIENTS WITH DILATED TRICUSPID ANNULUS UNDERGOING MITRAL SURGERY FOR DEGENERATIVE MITRAL REGURGITATION: A PROSPECTIVE RANDOMIZED STUDY

Abstract

Objectives: No randomized study has ever defined the role of prophylactic tricuspid annuloplasty (TA) during mitral surgery for degenerative mitral regurgitation (MR). The NOSTRUM trial is an ongoing prospective randomized study aiming at clarifying this issue. Its preliminary results are described. Methods: From June 2011, 43 patients undergoing mitral valve (MV) surgery for degenerative MR were randomized to receive (n = 19) or not receive (n = 24) concomitant TA (Edwards MC3 ring) for <2+ secondary tricuspid regurgitation (TR) and dilated tricuspid annulus (>21 mm/m2). Results: Aortic cross‐clamp time was longer in the treatment group (75 +/‐ 19 vs 58 +/‐ 18 min, P = 0.005). Postoperative morbidity was similar (no patient required a permanent pacemaker). At follow‐up (100% complete, median length 12 months, IQR 7, 12.3), TR was absent in 78.9% (15/19) vs 8.3% (2/24) of patients in the treatment and control groups (P = 0.0001). Tricuspid regurgitation >2+ was documented in 10.5% (2/19) vs 54% (13/24) of patients, respectively (P = 0.003). In the control group the size of the dilated tricuspid annulus did not decrease at follow‐up (P = 0.8), RV end‐systolic diameter increased (from 16 +/‐ 3.9 to 18 +/‐ 4.1 mm, P = 0.05) and the peak systolic velocity of the tricuspid annulus significantly decreased (from 11 +/‐ 0.4 to 10 +/‐ 0.8 cm/s, P = 0.002). At multivariate analysis, TA was the most important factor in preventing the persistence/ occurrence of TR 2+ (HR 0.1, CI 95% 0.02‐0.5, P = 0.006). Conclusions: Prophylactic tricuspid annuloplasty in the setting of degenerative MR, does not increase postoperative morbidity, restores valve competence and prevents TR progression at early follow‐up. When annuloplasty is not performed, preoperative tricuspid annular dilatation and TR do not improve, possibly leading to progression of RV remodelling.