Letter to the editor Simultaneous percutaneous repair in mitral and tricuspid regurgitation: step by step. Response

To the Editor,

First of all, we would like to thank Sánchez Vega et al. for the interest shown in our recent article. The field of combined interventional cardiology for mitral and tricuspid regurgitation (TR) is in its early stages, and the scientific evidence is still not sufficiently strong. Therefore, it is only natural that questions arise about these complex procedures. Nonetheless, some arguments support combined repair in certain cases. The presence of severe TR at the time of mitral repair has been reported to be associated with poorer prognosis, even in the short-term.^1,2 Furthermore, although TR is theoretically significantly reduced after mitral repair, this outcome is seen in only 15% to 40% of patients.³ Consequently, a number of patients could experience clinical deterioration due to residual TR. Factors such as annular dilatation, degree of TR, right-sided dysfunction and dilatation, or the presence of congestive symptoms may indicate that the TR will not improve and that there is a risk of adverse events during follow-up. Once the decision has been made to treat both valves, combined treatment appears to have advantages. It is safe and feasible, it shortens the duration of the procedure compared with 2 deferred procedures, and it lowers the risks associated with a new vascular access, another hospital stay, and repeat general anesthesia in patients already at high risk. Randomized studies would be ideal, but definitive conclusions might not be reached, given the heterogeneity of the condition. In the interim, our decisions should be guided by the clinical judgment and resources of the interventional cardiology team.