Background: Females with mitral valve disease have higher rates of tricuspid regurgitation(TR) than males. While tricuspid valve repair(TVr) decreases progression of TR, we hypothesize that there may be sex-based differences in concomitant TVr at the time of mitral surgery.
Methods: Adults undergoing mitral surgery for degenerative disease with moderate or worse preoperative TR at a high-volume center from 2014-2023 were identified. Patients with 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 female (55%, n=214/388) and the median age was 73(Q1-Q3:65-79). There was no difference in the rate of severe TR by sex (female:28%; male:26%, p=0.63). The unadjusted rate of concomitant TVr was 57% for females and 73% for males(p<0.001). Overall, females had 52% lower adjusted odds of TVr (ORadj:0.48, 95%CI 0.29-0.81, p=0.006), including a lower adjusted rate for moderate (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 females and 0% of males had severe TR or required valve-related reoperation at four years (p<0.001) CONCLUSIONS: Females with moderate or severe TR undergoing mitral surgery for degenerative disease were less likely to receive concomitant TVr and more likely to develop severe TR or need valve-related reoperation. Evaluation of sex-based treatment differences is imperative to improve outcomes for females.
Copyright © 2024. Published by Elsevier Inc.