Sex-Based Differences in Concomitant Tricuspid Repair During Degenerative Mitral Surgery.

Background: Women with mitral valve disease have higher rates of tricuspid regurgitation (TR) than men. Although tricuspid valve repair (TVr) decreases the progression of TR, we hypothesize that there may be sex-based differences in concomitant TVr at the time of mitral valve operations.
Methods: Adults undergoing mitral valve operation for degenerative disease with moderate or worse preoperative TR at a high-volume center from 2014 to 2023 were identified. Patients with a previous tricuspid intervention were excluded. A multivariable logistic regression identified predictors of concomitant TVr. To evaluate the clinical impact of not performing TVr, a competing risk model compared development of severe TR or valve-related reoperation by sex among patients without TVr.
Results: Most included patients were women (55% [n = 214 of 388]), and the median age was 73 years (quartile 1-quartile 3, 65-79 years). There was no difference in the rate of severe TR by sex (female, 28%; male, 26%; P = .63). The unadjusted rate of concomitant TVr was 57% for women and 73% for men (P < .001). Overall, women had 52% lower adjusted odds of TVr (adjusted odds ratio, 0.48; 95% CI, 0.29-0.81; P = .006), including a lower adjusted rate for moderate TR (47% [95% CI, 45%-49%] vs 66% [95% CI, 64%-69%]) and for severe TR (83% [95% CI, 81%-86] vs 92% [95% CI, 90%-93%]) Among those without TVr, 12% of women and 0% of men had severe TR or required a valve-related reoperation at 4 years (P < .001).
Conclusions: Women with moderate or severe TR undergoing mitral valve operation for degenerative disease were less likely to receive concomitant TVr, severe TR was more likely to develop, or they would more likely need a valve-related reoperation. Evaluation of sex-based treatment differences is imperative to improve outcomes for women.
Competing Interests: Disclosures Gorav Ailawadi reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory; with Medtronic that includes: consulting or advisory; with AtriCure Inc that includes: consulting or advisory; with Abbott that includes: consulting or advisory; with W. L. Gore & Associates Inc that includes: consulting or advisory; with anteris medical GmbH that includes: consulting or advisory; with Arthrex Inc that includes: consulting or advisory; with JenaValve Technology Inc that includes: consulting or advisory; and with Ethicon Inc that includes: consulting or advisory. Donald Likosky reports a relationship with Blue Cross Blue Shield of Michigan that includes: funding grants; and with AmSECT that includes: consulting or advisory. Steven Bolling reports a relationship with Edwards that includes: consulting or advisory; with Medtronic Inc that includes: consulting or advisory; with AtriCure Inc that includes: consulting or advisory; with Abbott that includes: consulting or advisory; and with W. L. Gore & Associates Inc that includes: consulting or advisory. Matthew Romano reports a relationship with Edwards Lifesciences Corporation that includes: consulting or advisory; with Medtronic Inc that includes: consulting or advisory; and with AtriCure that includes: consulting or advisory. The other authors have no conflicts of interest to disclose.
(Copyright © 2024 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)