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Impact of Concomitant Tricuspid Annuloplasty on Tricuspid Regurgitation Right Ventricular Function and Pulmonary Artery Hypertension After Degenerative Mitral RepairJoanna Chikwe, MDProfessorDepartment of Cardiovascular SurgeryMount Sinai Medical CenterNew York New York

The senior author of this studiy, Dr David Adams, has the following disclosures.1DisclosuresThe Icahn School of Medicine at Mount Sinai receives royalties from Edwards Lifesciences and Medtronic for Dr. David Adams involvement in developing two mitral valve repair rings and one tricuspid valve repair ring.

Dr. David Adams is the National Co-Principal Investigator of the CoreValve United States Pivotal Trial, which is supported by Medtronic.

None of the sponsoring organizations had any role in the design and conduct of the study.

None of the other authors have any conflicts of interest to disclose.. 2

The senior author of this studiy, Dr David Adams, has the following disclosures.2

Functional tricuspid regurgitation

3Rationale

Moderate TR is not benignTR is downgraded by intraoperative TEECorrecting left sided lesions alone does not prevent TR TR repair is safeTR repair is effective

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Carpentier A J Thorac Cardiovasc Surg 1983 86; 323-337

Specifically5

Carpentier A J Thorac Cardiovasc Surg 1983 86; 323-337

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Carpentier A J Thorac Cardiovasc Surg 1983 86; 323-337

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Carpentier A J Thorac Cardiovasc Surg 1983 86; 323-337

8Consensus GuidelinesACC / AHA 2014Class I: TV repair for severe TR in patients undergoing MVR (C)

Class IIa: TV repair for mild, moderate or greater functional TR in patients undergoing MV surgery, when there is prior evidence of right heart failure or TV dilatation* (B)

* >40mm diameter, or 21mm/m2, or >70mm on direct intraoperative measurement

ESC 2012Class I: Severe TR in patients undergoing left sided valve surgery (C)

Class IIa: Mild or moderate secondary TR with dilated annulus* in a patient undergoing left sided valve surgery (C)

* >40mm diameter, or 21mm/m2, or >70mm on direct intraoperative measurement

Consensus GuidelinesACC / AHA 2014Class I: TV repair for severe TR in patients undergoing MVR (C)

Class IIa: TV repair for mild, moderate or greater functional TR in patients undergoing MV surgery, when there is prior evidence of right heart failure or TV dilatation* (B)

* >40mm diameter, or 21mm/m2, or >70mm on direct intraoperative measurement

ESC 2012Class I: Severe TR in patients undergoing left sided valve surgery (C)

Class IIa: Mild or moderate secondary TR with dilated annulus* in a patient undergoing left sided valve surgery (C)

* >40mm diameter, or 21mm/m2, or >70mm on direct intraoperative measurement

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Carpentier A J Thorac Cardiovasc Surg 1983 86; 323-337

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Rationale

Moderate tricuspid regurgitation is not benignCorrecting left sided lesions alone does not prevent TR TR repair is associated with better functional outcomesTR is downgraded by intraoperative TEE

Moderate TR is not benignDaysN=5223, p