Functional Tricuspid Valve Regurgitation Research Articles

Letter to the Editor: Insight into functional tricuspid valve regurgitation pathogenesis, pathological stages, and surgical management

Letter to the Editor: Insight into functional tricuspid valve regurgitation pathogenesis, pathological stages, and surgical management

Unusual origins of cardiac insufficiency: a case of iliac arteriovenous fistula post-spinal disc surgery

In this case report, we present the unique and intriguing case of a 57-year-old man who experienced exertional palpitations and shortness of breath for 5 years. He was diagnosed with idiopathic heart failure three years ago, leading to diuretic treatment. Physical examination revealed notable left lower extremity swelling, severe varicose veins, and cardiac murmurs. Echocardiography showed significant cardiac enlargement and severe functional mitral and tricuspid valve regurgitation. Computed tomography (CT) imaging uncovered a 10 mm left common iliac arteriovenous fistula, causing abnormal early filling of the inferior vena cava (IVC) and marked IVC dilation. Open surgical repair of the arteriovenous fistula resulted in symptom relief and improved cardiac function. This case underscores the importance of considering unusual causes in heart failure patients and highlights the value of early diagnosis and intervention in complex cardiac-vascular interactions.

Prognostic value of tricuspid valve regurgitation in patients with pulmonary arterial hypertension and CTEPH: A longitudinal study

AimsThe prognostic value of functional tricuspid valve regurgitation (TR) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study primarily aims to quantify the prognostic role of TR in relation to right ventricle (RV) dysfunction on clinical outcomes and secondarily the evolution of TR and RV dysfunction over time. MethodsAdult PAH or CTEPH patients diagnosed by right heart catheterization were included. Exclusion criteria were prevalent patients and age < 18 years.The primary endpoint was a composite of death or lung transplantation. Longitudinal evolution of TR and RV dysfunction were modelled with generalized mixed-effect models, which were inserted in a cox model under the joint-modelling framework in order to investigate the association of TR and RV dysfunction with the endpoint. ResultsWe included 76 PAH and 44 CTEPH patients (median age:59, females:62 %), with a mean follow-up of 3.2 ± 2.1 years. 31 patients reached the endpoint (2 transplant, 29 mortality). On average the probability of moderate-to-severe TR decreased during follow-up, whereas the probability of moderate-to-severe RV dysfunction remained stable. The cumulative effect of moderate-to-severe TR (HRper day 1.01 95 %CI[1.00–1.01],P < 0.001) and moderate-to-severe RV dysfunction (HRper day: 1.01 95 %CI[1.00–1.01],P < 0.001) was associated with the endpoint in univariable joint-models. In a multivariable joint-model with both the evolutions of TR and RV dysfunction only TR remained significant (HR per day: 1.01 95 %CI[1.00–1.01],P < 0.001). ConclusionPersistent moderate-to-severe tricuspid valve regurgitation during follow-up predicts adverse outcomes and might be a better predictor of lung transplantation and mortality compared to right ventricle dysfunction.

Abstract 15479: High Output Cardiac Failure Associated With Arteriovenous Fistula

Introduction: High output heart failure (HOHF) secondary to arteriovenous fistula (AVF) is known. However, having a high index of suspicion for the latter when encountering diuretic resistance in patients with a remote history of hemodialysis is key. Case A 68-year-old female with a history of kidney transplant in 2012 with no recent dialysis, hypertension, hyperlipidemia, pulmonary hypertension, heart failure with reduced ejection fraction, and atrial fibrillation presented with decompensated heart failure and acute kidney injury (AKI). Physical exam was remarkable for anasarca, and no apparent fistulas were noted. She was started on milrinone and furosemide drips. Clinical decision making Initial transthoracic echocardiogram (TTE) revealed an ejection fraction (EF) of 20%, which declined from 35%, along with new mitral and tricuspid regurgitation. Her hospitalization was complicated by altered mental status, worsening AKI requiring hemodialysis, atrial fibrillation with rapid ventricular response, and resistance to multiple diuretics and after-load reduction combinations. Diuretics and inotropic support were discontinued due to worsening clinical status. Given concerns for valvular disease, a transesophageal echocardiogram was obtained, confirming moderate to severe mitral and tricuspid valve regurgitation, bi-atrial enlargement, and reduced biventricular function. However, the patient was not clinically optimized for Mitra-clip. Further hemodynamics and volume status assessment with RHC revealed a mean PAP 44, PCWP 26, and CO 11 L/min. RHC results raised suspicion for HOHF. Interestingly, the patient was noted to have a right inguinal surgical scar with a palpable thrill, and an arteriovenous graft duplex revealed high volume flow. The patient underwent ligation of the right inguinal fistula. Repeat TTE two weeks post AVF ligation showed EF of 40% and improved functional mitral and tricuspid valve regurgitation. The patient ultimately was taken off hemodialysis and had clinically improved heart failure. GDMT was optimized, and outpatient evaluation for mitral valve intervention was scheduled. Conclusion Longstanding AVF can cause HOHF. Early index of suspicion is warranted for AVF ligation as it results in rapid EF recovery.

Transcatheter closure of atrial septal defect in the elderly: a systematic review and meta-analysis

ObjectiveDespite the establishment of transcatheter closure as the treatment of choice in adults with secundum atrial septal defects (ASDs), the effectiveness of this approach in the elderly is disputed. This...

The prognostic significance of right ventricular basal diameter in addition to tricuspid annulus diameter in patients underwent to tricuspid valve surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background Functional tricuspid valve regurgitation occurs as a result of enlargement of the tricuspid annulus (TA) despite the normal valve structure (1). However, the tendency of the tricuspid annulus to enlarge in the posterior annular part suggests that the mediolateral diameter measurement measured by 2-dimensional (2-D) echocardiography does not provide an accurate anatomical evaluation (2). Inaccuracies in these measurements also affect the selection of the tricuspid ring in patients undergoing surgery and thus affect the short- and long-term outcomes (3). Therefore, new methods and reference points have developed in the measurement of the tricuspid annulus. Purpose In this study, we aimed to investigate the importance of apical 4-chamber tricuspid annulus diameter and right ventricular basal diameter measurements in choosing a surgical tricuspid ring size. Methods The records of 359 patients who underwent tricuspid ring annuloplasty for functional tricuspid valve regurgitation between 2018 and 2022 were retrospectively reviewed. Tricuspide anulus and right ventricular basal diameter measurements were re-evaluated echocardiographically, and surgical tricuspid ring sizes were recorded. Results There was no significant relationship between 2-D measurement of tricuspid annulus diameter and choosing surgical ring sizes (OR 0.74, 95% CI 0.51 – 1.09, p = 0.257), however, the increase in RV basal diameter size was associated with larger ring size selection (OR 2.63, 95%). CI 1.72 – 4.02, p&amp;lt;0.0001). Among the 5 models that predicted the surgical ring size according to the ordinal regression analysis, the models that most accurately predicted the surgical ring size were model-4, which included RV basal diameter, and model-5, which included RV basal diameter and TA diameter. (Table 1). Also, in model-5, RV basal diameter was superior to TA-diameter in showing variation in surgical ring size. Also, when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is &amp;lt; 45 mm, the large ring selection rate (34 or 36) is 36.2%, but this rate is 70.9% when the TA diameter is &amp;lt; 40 mm and the RV basal diameter is ≥ 45. Conclusions In conclusion, when the measurements in the apical 4-chamber were compared, the effectiveness of the measurement of the tricuspid annulus in determining the surgical ring size was lower than the RV basal diameter. During pre-operative evaluation, RV basal measurement in addition to the tricuspid annulus may help in the selection of patients who require tricuspid valve annuloplasty and in determining the ring sizes.

Tricuspid regurgitation in the setting of LVAD support.

Tricuspid valve regurgitation (TR) is a common complication of end-stage heart failure. Increased pulmonary venous pressures caused by left ventricular (LV) dysfunction can result in a progressive dilation of the right ventricle and tricuspid valve annulus, resulting in functional TR. Here, we review what is known about TR in the setting of severe LV dysfunction necessitating long-term mechanical support with left ventricular assist devices (LVADs), including the occurrence of significant TR, its pathophysiology, and natural history. We examine the impact of uncorrected TR on LVAD outcomes and the impact of tricuspid valve interventions at the time of LVAD placement, revealing that TR frequently improves after LVAD placement with or without concomitant tricuspid valve intervention such that the benefit of concomitant intervention remains controversial. We summarize the current evidence on which to base medical decisions and provide recommendations for future directions of study to address outstanding questions in the field.

Comparative study of tricuspid valve repair using ring vs. synthetic band in severe functional tricuspid valve regurgitation

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease remains a common problem. There are different surgical techniques for tricuspid valve repair; however, the superiority of one approach over the other has not been proven. Our objective was to compare the short-term results of ring versus synthetic band annuloplasty to repair functional severe tricuspid regurgitation in patients with left-sided valve lesions.&#x0D; Methods: This retrospective study includes 60 patients who underwent left-sided valve replacement with concomitant tricuspid valve repair for severe tricuspid regurgitation. Patients were divided into group A (n= 30), patients with rigid rings, and group B (n= 30), patients with synthetic bands.&#x0D; Results: The preoperative demographic and clinical data were non-significant between both groups. In the preoperative data, the tricuspid annular plane systolic excursion (TAPSE) was significantly higher in the ring group (2.84 ± 0.53 vs. 2.3 ± 0.4, P&lt; 0.001). Hospital stay was more prolonged in group B (10.05 ± 1.57 vs. 11.7 ± 2.76 days, P=0.006). There were no differences in other operative and postoperative data between groups. After a six-month follow-up, both groups had no significant difference regarding the clinical data or the degree of tricuspid valve regurgitation.&#x0D; Conclusion: Tricuspid valve annuloplasty with a rigid ring or synthetic band for tricuspid regurgitation could have a good short-term outcome.

Interventional treatment of heart failure : Stents and valves

The pharmacotherapy of heart failure has evolved in recent years and with the aid of new classes of drugs symptomatic and prognostic improvements can be achieved in patients with heart failure. Heart failure is particularly frequently associated with coronary artery disease or higher grade, often functional valve defects. In the context of the underlying disease, the operative risk is often increased, so that interventional treatment is preferred over surgical treatment options in interdisciplinary heart teams. Promising approaches with very different challenges are emerging for interventional myocardial revascularization and percutaneous correction of high-grade aortic valve stenosis or functional mitral or tricuspid valve regurgitation. It has consistently been shown that an elaborate diagnostic work-up and differentiated patient selection are decisive to achieve aprognostic or symptomatic benefit in these patients using interventional treatment. While awaiting further study data on this topic, the integration of amultidisciplinary heart team is essential to ensure acomplementary and balanced therapeutic approach for patient-centered care in this complex patient population.

Outcome of suture annuloplasty (De Vega) versus ring annuloplasty for functional tricuspid valve regurgitation concomintant with mitral valve surgery

Outcome of suture annuloplasty (De Vega) versus ring annuloplasty for functional tricuspid valve regurgitation concomintant with mitral valve surgery

Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Isolated Tricuspid Valve Repair and Right Atrial Plication Performed Using a Beating-Heart Technique for Atrial Functional Tricuspid Valve Regurgitation

Different Causes of Functional Tricuspid Valve Regurgitation Are Linked to Differences in Tricuspid Valve and Right-Sided Heart Geometry and Function: 3D Echocardiography Study.

Background and Objectives: The aim of this study was to clarify the tricuspid valve (TV) and right ventricular (RV) geometry and function characteristics using 3D echocardiography-based analysis and to identify echocardiographic predictors for severe tricuspid regurgitation (TR) in different etiologies of functional TR (fTR). Methods and Results: The prospective study included 128 patients (median age 64 years, 57% females): 109 patients with moderate or severe fTR (69-caused by dominant left-sided valvular pathology (LSVP), 40 due to precapillary pulmonary hypertension (PH)), and 19 healthy controls. The 2D and 3D-transthoracic echocardiography analysis included TV, right atrium, RV geometry, and functional parameters. All the RV geometry parameters as well as 3D TV parameters were increased in both fTR groups when compared to controls. Higher RV diameters, length, areas, volumes, and more impaired RV function were in PH group compared to LSVP group. PH was associated with larger leaflet tenting height, volume, and more increased indices of septal-lateral and major axis tricuspid annulus (TA) diameters. LVSP etiology was associated with higher anterior-posterior TA diameter and sphericity index. Univariate and multivariate logistic regression and ROC analyses revealed that different fTR etiologies were associated with various 2D and 3D echocardiographic parameters to predict severe TR: major axis TA diameter and TA perimeter, the leaflet tenting volume had the highest predictive value in PH group, septal-lateral systolic TA diameter-in LSVP group. The 3D TA analysis provided more reliable prediction for severe fTR. Conclusions: TV and RV geometry vary in different etiologies of functional TR. Precapillary PH is related to more severe RV remodeling and dysfunction and changes of TV geometry, when compared to LSVP group. The 3D echocardiography helps to determine echocardiographic predictors of severe TR in different fTR etiologies.

Insight into functional tricuspid valve regurgitation pathogenesis, pathological stages, and surgical management

The tricuspid valve has generally been ignored, and considered as a “second class structure” in cardiac valve surgery. Tricuspid valve regurgitation is considered “functional” in over 70% of cases, generally produced by pulmonary hypertension secondary to left heart diseases in the context of an anatomically normal tricuspid valve apparatus. Many questions and doubts persist regarding to the pathogenesis of so-called functional tricuspid valve regurgitation. This article reviews the interfering factors in the function of the tricuspid valve to better identify the entity of the term “functional” and clarify its different pathological stages including the surgical procedures recommended in each stage.

Bicuspidized De Vega for Functional Tricuspid Valve Regurgitation: “De-Kay Repair”

Functional tricuspid valve regurgitation in the contest of mitral valve disease is a highly prevalent disease. We describe a ringless technique that combines restrictive annuloplasty (De Vega) with posterior tricuspid leaflet obliteration (Kay) used for patients with less-than-severe functional tricuspid valve regurgitation undergoing mitral valve surgery. The technique has been in use at our center since 2012, showing promising long-term echocardiographic results, with stable reduction of the annulus size and stable reduction of the degree of regurgitation.

Early Right Ventricular Reverse Remodeling Predicts Survival After Isolated Tricuspid Valve Surgery

BackgroundThere are limited data on the impact of isolated tricuspid valve (TV) surgery on recovery of right ventricular (RV) function and RV reverse remodeling. MethodsAmong 223 patients who had isolated TV procedures between 2001 and 2017, 60 (27%) underwent TV repair and 163 (73%) received TV replacement. Indication for surgery was functional tricuspid valve regurgitation in 64%, lead induced in 18%, and primary leaflet dysfunction in 18%. RV reverse remodeling was assessed by echocardiography at a median of 11.3 months (interquartile range [IQR] 5.9-13.5) post-dismissal. ResultsMean age was 67.3 ± 13.7 years, and 57% were female. Overall 30-day mortality was 2.7%. After a median follow-up period of 9.5 years (IQR 3.6-12.9), adjusted Cox regression analysis revealed comparable survival for TV repair and replacement and identified older age, and presence of RV dysfunction (hazard ratio [HR] 1.84, 95% confidence interval [CI] 1.14-2.98; P = .01), as independent predictors of poor survival. Patients who exhibited RV reverse remodeling within 18 months postoperatively had significantly improved survival compared with those who did not (log-rank P = .005), and reverse remodeling was independently associated with improved survival (HR 0.42, 95% CI 0.24-0.74; P = .003). Lower preoperative right atrial pressure (odds ratio 0.83, 95% CI 0.73-0.94; P = .004) was predictive of early RV reverse remodeling. ConclusionsIsolated TV surgery can be performed with acceptable outcomes (early mortality 2.7%), and overall survival is best in patients who receive the operation before developing RV systolic dysfunction. Adjusted survival was similar for patients undergoing TV repair or replacement. Early reverse remodeling of RV after surgery is associated with survival benefit.

Prognostic Value of Tricuspid Valve Regurgitation in Patients With Pulmonary Arterial Hypertension and CTEPH: A Longitudinal Study

Aims: The prognostic value of functional tricuspid valve regurgitation (TR) in patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension (CTEPH) remains undetermined. This study aims to quantify the prognostic role of TR during follow-up in relation to right ventricle (RV) dysfunction on clinical outcomes. Methods and Results: Patients from our prospective cohort study with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension were included. The primary endpoint was a composite of death or lung transplantation. The longitudinal evolution of TR and RV dysfunction were modelled with generalized mixed-effect models, which were inserted in a cox model under the joint-modelling framework in order to investigate the association of TR and RV dysfunction with the endpoint. In total, 120 patients were included (median age:59, females:62%), with a mean follow-up of 3.2±2.1 years. 31 patients reached the endpoint (2 transplant, 29 mortality). On average the probability of moderate-to-severe TR decreased during follow-up, whereas the probability of moderate-to-severe RV dysfunction remained stable over time. The cumulative effect of moderate-to-severe TR (hazard ratio: 1.01 95%CI[1.00-1.01],P<0.001) and moderate-to-severe RV dysfunction (hazard ratio: 1.01 95%CI[1.00-1.01],P<0.001) was associated with the composite endpoint in univariable joint-models. In a multivariable joint-model with both the evolutions of TR and RV dysfunction only TR remained a significant predictor (hazard ratio: 1.01 95%CI[1.00-1.01],P<0.001). Conclusion: Persistent moderate-to-severe tricuspid valve regurgitation during follow-up predicts adverse outcomes and might be a better predictor of lung transplantation and mortality compared to right ventricle dysfunction.

Impact of tricuspid regurgitation and its postprocedural reduction on long term outcome in patients undergoing percutaneous mitral valve edge to edge repair

Abstract Background Prevalence of functional tricuspid valve regurgitation (TR) in the adult population is high and mostly considered as a consequence of left-sided heart failure. In patients with moderate-to-severe and severe mitral regurgitation (MR), relevant concomitant TR is found in about 30–50%. For many years the concept of a reduction of secondary TR after mitral valve surgery has been widely accepted. However, more recently, compelling data have shown that surgically untreated functional TR can persist or even worsen despite the correction of the associated left-sided lesion. In line with previous research, studies have indicated that preexisting concomitant TR is an independent predictor for adverse outcome in patients undergoing percutaneous mitral valve Edge-to-Edge Repair (pMVR). Purpose This study intends to determine the extent to which the severity of tricuspid regurgitation, measured six months after pMVR, impacts the outcome. Methods Between September 2008 and July 2018, 805 consecutive patients with moderate-to-severe or severe MR underwent pVMR therapy with the MitraClip device at our center. We exclude patients with missing date of follow-up (n=54) and patients with missing values for baseline tricuspid regurgitation (n=93). We analyze, therefore, data of 658 patients with a median follow-up time of 4.93 (4.2, 4.99) years. Severity of TR was evaluated at baseline and six months after pMVR. Results Among 658 high-risk patients (mean age 75.4±8.7 years, 59.7% male, median STS Score 3.9 [2.4, 6.1]), 248 patients were suffering from no/mild (37.6%), 213 from moderate (32.6%) and 197 patients from severe (29.9%) TR. Functional MR was present in 429 (65.5%) patients. Procedural success was achieved in the majority of patients (no/mild TR 90.3%, moderate TR 91.1%, severe TR 90.4%). Overall, mortality rates up to two-year follow-up were highest for patients with severe TR (no/mild TR 30.2%, moderate TR 37.6%, severe TR 42.6%, p=0.023). The risk for overall mortality (Kaplan-Meier analysis, p=0.0027, Figure 1) was related to increasing TR severity. However, Kaplan-Meier analysis showed no relevant differences for the combined endpoint of death and rehospitalization (p=0.058). Interestingly, in a pairwise comparison, the risk for patients with pre-existing severe TR and postprocedural reduction to mild or moderate TR (n=17) was reduced for the combined endpoint (p=0.021) compared to patients with persistent severe TR (n=28). Conclusion Moderate and severe TR in high-risk patients undergoing pMVR is associated with an increased risk for overall mortality. While preliminary, the presented data suggest a favorable outcome in patients with a postprocedural reduction in the severity of TR. The results of this study indicate the importance of developing new therapeutic strategies in high-risk patients with combined MR and TR, probably leading to concomitant tricuspid valve interventions. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 312: The Tricuspid Valve Also Maladapts: Evidence From Sheep With Functional Tricuspid Regurgitation

The objective of this work was to determine whether tricuspid valve leaflets maladapt to functional regurgitation as they do in the mitral valve. If they did, pharmacological control of the underlying mechanisms could open opportunities to support tricuspid valve surgery and improve currently poor outcomes. To this end, we used a biventricular heart failure model to induce functional tricuspid valve regurgitation in sheep. We sacrificed animals once they showed signs of heart failure (with in 2-3 weeks). In those animals (and controls), we measured tricuspid anterior leaflet area and thickness, collagen content via ELISAs, tissue stiffness via mechanical testing, and cellular changes via immunohistochemistry. We found a statistically significant increase with disease in leaflet area (p=0.004), thickness (p=0.037), collagen content (p=0.001), circumferential leaflet stiffness (p=0.001), and SMA (p=0.030), Figure 1. Our findings imply that in approximately 2-3 weeks of biventricular heart failure and associated functional tricuspid regurgitation, tricuspid valve leaflets underwent substantial remodeling. Specifically, it appears that activation of valvular interstitial cells increased collagen syntheses resulting in leaflet growth, thickening, and stiffening. No other previous study has demonstrated tissue maladaptation on all functional scales in the tricuspid valve. Our work is relevant as it implies that pharmacological control of this maladaptive response could allow for the promotion of the positive effects (e.g., area increase) while suppressing negative effects (e.g., fibrosis).

A pilot in silico modeling-based study of the pathological effects on the biomechanical function of tricuspid valves.

Current clinical assessment of functional tricuspid valve regurgitation relies on metrics quantified from medical imaging modalities. Although these clinical methodologies are generally successful, the lack of detailed information about the mechanical environment of the valve presents inherent challenges for assessing tricuspid valve regurgitation. In the present study, we have developed a finite element-based in silico model of one porcine tricuspid valve (TV) geometry to investigate how various pathological conditions affect the overall biomechanical function of the TV. There were three primary observations from our results. Firstly, the results of the papillary muscle (PM) displacement study scenario indicated more pronounced changes in the TV biomechanical function. Secondly, compared to uniform annulus dilation, nonuniform dilation scenario induced more evident changes in the von Mises stresses (83.8-125.3 kPa vs 65.1-84.0 kPa) and the Green-Lagrange strains (0.52-0.58 vs 0.47-0.53) for the three TV leaflets. Finally, results from the pulmonary hypertension study scenario showed opposite trends compared to the PM displacement and annulus dilation scenarios. Furthermore, various chordae rupture scenarios were simulated, and the results showed that the chordae tendineae attached to the TV anterior and septal leaflets may be more critical to proper TV function. This in silico modeling-based study has provided a deeper insight into the tricuspid valve pathologies that may be useful, with moderate extensions, for guiding clinical decisions. NOVELTY STATEMENT: The novelties of the research are summarized below: A comprehensive in silico pilot study of how isolated functional tricuspid regurgitation pathologies and ruptured chordae tendineae would alter the tricuspid valve function; An extensive analysis of the tricuspid valve function, including mechanical quantities (eg, the von Mises stress and the Green-Lagrange strain) and clinically-relevant geometry metrics (eg, the tenting area and the coaptation height); and A developed computational modeling pipeline that can be extended to evaluate patient-specific tricuspid valve geometries and enhance the current clinical diagnosis and treatment of tricuspid regurgitation.

Should Moderate Functional Tricuspid Regurgitation Be Repaired During Surgery for Rheumatic Mitral Valve Disease?

Surgical repair of concomitant functional moderate tricuspid valve (TV) regurgitation at the time of mitral valve (MV) surgery remains controversial. The objective of this study was to evaluate the outcomes of concomitant repair of functional moderate tricuspid regurgitation (TR) during MV surgery for rheumatic valve disease. From 1998 to 2016, 1,240 patients had rheumatic MV disease associated with moderate functional TR: 974 patients had MV surgery and concomitant TV repair (group 1) and 266 patients had MV surgery alone (group 2). Study endpoints were operative outcomes, rehospitalisation for congestive heart failure (CHF), and TV reintervention. Propensity score matching identified 192 well-matched pairs for outcomes comparison. Patients who had concomitant TV repair were younger (p=0.02) and there were fewer diabetics (p=0.015). In matched patients, low cardiac output was significantly higher in group 2 (p=0.044) and there was no difference in ventilation time, intensive care unit stay, cardiopulmonary bypass, and ischaemic times (p=0.480, p=0.797, p=0.232, and p=0.550, respectively) between groups. Patients in group 2 required more TV reintervention (1 vs 35 in group 1 and 2, respectively; p=0.004) and rehospitalisation for CHF (5 vs 40 in group 1 and 2, respectively; p<0.001). Concomitant TV repair for moderate TR in patients undergoing rheumatic MV surgery was not associated with increased operative risk. Postoperative low cardiac output syndrome and the risk of late TV reinterventions and rehospitalisation for CHF were lower with TV repair. Concomitant repair of the moderate TV regurgitation maybe beneficial for patients undergoing rheumatic MV surgery.