Serial Changes of Transmitral and Transtricuspid Pressure Gradients After Simultaneous Mitral and Tricuspid Ring Annuloplasty

Background: Although flexible-ring annuloplasty is more inclined to increase the transmitral gradient over time, its effect on the tricuspid annulus is unknown. This study was conducted to evaluate serial changes in mean pressure gradient (mPG) across tricuspid and mitral valves after simultaneous dual implantation of flexible bands. Methods: Seventy-one (71) patients (median age, 61.6 years; IQR: 50.8–69.0 years) underwent simultaneous mitral/tricuspid annuloplasties using St. Jude Tailor rings. Serial mPGs across mitral and tricuspid valves were evaluated at three postoperative time points: predischarge, 3 years, and 5 years. To gauge the effects and clinical outcomes of prophylactic intervention, patients were categorised as tricuspid regurgitation (TR) ≥ moderate or TR < moderate. The median follow-up period was 125 months (IQR: 109–137 months). Results: Unlike transmitral mPG, which increased over time (predischarge, 2.94; 3 years, 3.61; 5 years, 3.87; p < 0.0005), transtricuspid mPG did not change (predischarge, 1.65; 3 years, 1.69; 5 years, 1.69; p = 0.906). Preoperative TR grade had no impact on serial changes in transtricuspid mPG (TR ≥ moderate, p = 0.542; TR < moderate, p = 0.608). Three observed late recurrences of TR ≥ moderate degree displayed TR ≥ moderate at baseline, and overall mortality was higher in the TR ≥ moderate group (p = 0.01). Conclusions: Flexible-band annuloplasty did not promote stenosis of tricuspid valves at mid-term follow-up. These findings confirm the safety of prophylactic tricuspid annuloplasty (via flexible band) as an adjunct to mitral annuloplasty.