What’s the Best Way to Fix ‘Leaky’ Heart Valves?

By Jonathan Springston, Editor, Relias Media

For patients with tricuspid or mitral regurgitation, or “leaky” heart valves, investigators discovered those who underwent mitral valve surgery plus tricuspid annuloplasty fared better than those who underwent only mitral valve repair. Specifically, the researchers observed that over a two-year period, the former group was less likely to die, less likely to need a reoperation, and less likely to experience severe stage regurgitation vs. the mitral valve surgery alone group.

Millions of patients are diagnosed with leaky heart valves annually, which can necessitate surgical repair. The mitral valve procedure is more minor, a repair of tissue that could lead to additional adjustments or even valve replacement. Another option is tricuspid annuloplasty, whereby surgeons resize or reshape the suspect valve. Although both procedures can be performed concurrently, many patients pick one procedure or the other.

In 2016, researchers from the Cardiothoracic Surgical Trials Network enrolled 401 patients who were undergoing treatment for worsening mitral valve regurgitation with mild to moderate tricuspid regurgitation. All planned to undergo mitral valve surgery; the researchers randomized the patients into two groups: mitral valve surgery alone or mitral valve surgery plus tricuspid annuloplasty. Procedures were performed in 39 medical centers across Canada, Germany, and the United States.

After two years, among patients who underwent both procedures, 3.9% died, developed severe regurgitation, or needed a reoperation vs. 10.2% in the mitral valve surgery alone group. The authors observed no significant differences between patient groups in quality of life or changes in functional status. However, 14.1% of patients who underwent both procedures required a permanent pacemaker vs. 2.5% in the mitral valve surgery alone group.

Two authors from the research group presented their findings on Nov. 13 during the American Heart Association Scientific Sessions 2021, indicating that additional, longer-term follow-up and additional research are needed to draw firm conclusions about what the best approach might be. Part of that follow-up will include closer scrutiny on patients who needed a pacemaker and working with patients with less severe valve leaks. The authors of this latest work hope a collective body of work can guide future treatment guideline decisions among relevant medical associations.

On a related note, as reported in the upcoming December 2021 issue of Clinical Cardiology Alert, an analysis of a real-world database revealed 14% of patients undergoing routine transfemoral transcatheter aortic valve replacement required permanent pacemaker implantation within 30 days of the valve procedure. There was no difference in long-term survival between patients who did and did not undergo pacemaker implant.

Additionally, the November 2021 issue of Clinical Cardiology Alert includes an article about a way to measure frailty before aortic valve replacement — modified body mass index (mBMI). Specifically, a review of transcatheter vs. surgical aortic valve implantation showed mBMI predicted one-year all-cause mortality and postoperative complications.