We sought to characterize the clinical outcomes and to identify predictors of mortality
undergoing isolated tricuspid valve surgery in the United States. We identified 5,164
patients undergoing isolated tricuspid valve surgery from the Centers for Medicare
and Medicaid Services Medicare Provider Analysis and Review data between January 2003
and December 2014. The primary outcome was all cause 1-year mortality. A backward
elimination method was performed to identify predictors of 1-year mortality. Tricuspid
valve repair was performed in 2,494 (48.3%) patients and tricuspid valve replacement
was performed in 2,670 (51.7%) patients. Perioperative and 1-year mortality rates
were 9.9% and 24.1%, respectively. Predictors of 1-year mortality were age (p <0.001),
chronic heart failure (p = 0.001, cirrhosis (p <0.001), carcinoid syndrome (p <0.001),
chronic kidney disease (p = 0.001), secondary pulmonary hypertension (p = 0.023),
endocarditis (p = 0.005), decubitus ulcer (p <0.001), malnutrition (p <0.001), replacement
(p = 0.013), emergency procedure (p <0.001), and preprocedural shock (p <0.001). The
C-statistic for 1-year mortality was 0.70 (95% confidence interval, 0.67 to 0.73).
In conclusion, isolated tricuspid valve surgery is infrequently performed in the United
States, and is associated with high 1-year mortality. Patients at higher risk for
mortality can be identified based on the presence of a number of comorbidities at
the time of surgery.
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References
- The growing clinical importance of secondary tricuspid regurgitation.J Am Coll Cardiol. 2012; 59: 703-710
- Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation (the Framingham Heart Study).Am J Cardiol. 1999; 83: 897-902
- Functional tricuspid regurgitation: a more complex entity than it appears.Heart. 2009; 95: 868-869
- Tricuspid valve dysfunction following pacemaker or cardioverter-defibrillator implantation.J Am Coll Cardiol. 2017; 69: 2331-2341
- Impact of tricuspid regurgitation on long-term survival.J Am Coll Cardiol. 2004; 43: 405-409
- Clinical outcome of isolated tricuspid regurgitation.JACC Cardiovasc Imaging. 2014; 7: 1185-1194
- Tricuspid regurgitation contributes to renal dysfunction in patients with heart failure.J Card Fail. 2008; 14: 824-830
- Right ventricular function in cardiovascular disease, part II: pathophysiology, clinical importance, and management of right ventricular failure.Circulation. 2008; 117: 1717-1731
- Mechanism and Implications of the Tricuspid Regurgitation: From the Pathophysiology to the Current and Future Therapeutic Options.Circ Cardiovasc Interv. 2017; 10: 1-12
- 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.Circulation. 2014; 129: 2440-2492
- Beating heart versus arrested heart isolated tricuspid valve surgery.Int Heart J. 2015; 56: 400-407
- Long-term survival after isolated tricuspid valve replacement.Heart Lung Circ. 2014; 23: 697-702
- Surgical outcomes of isolated tricuspid valve procedures: repair versus replacement.Ann Cardiothorac Surg. 2017; 6: 214-222
- Repair or replacement for isolated tricuspid valve pathology? Insights from a surgical analysis on long-term survival.Med Sci Monit. 2017; 23: 1017-1025
- Isolated tricuspid valve surgery at a single centre: the 47-year Auckland experience, 1965-2011.Interact Cardiovasc Thorac Surg. 2014; 18: 27-32
- Clinical and echocardiographic outcomes after surgery for severe isolated tricuspid regurgitation.J Thorac Cardiovasc Surg. 2013; 146: 278-284
- Determinants of surgical outcome in patients with isolated tricuspid regurgitation.Circulation. 2009; 120: 1672-1678
- Mortality, hospitalizations, and expenditures for the Medicare population aged 65 years or older, 1999-2013.JAMA. 2015; 314: 355-365
- Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database.J Thorac Cardiovasc Surg. 2012; 143: 1043-1049
- Reoperations after tricuspid valve repair: re-repair versus replacement.J Thorac Dis. 2016; 8: 133-139
- Outcomes of tricuspid valve repair and replacement: a propensity analysis.Ann Thorac Surg. 2009; 87: 83-88
- Long-term results (up to 14 years) of the clover technique for the treatment of complex tricuspid valve regurgitation.Eur J Cardiothorac Surg. 2017; 52: 125-130
- Eight-year outcomes of tricuspid annuloplasty using autologous pericardial strip for functional tricuspid regurgitation.Ann Thorac Surg. 2008; 86: 1485-1492
- Model for end-stage liver disease predicts mortality for tricuspid valve surgery.Ann Thorac Surg. 2009; 87: 1460-1467
- Tricuspid valve and percutaneous approach: No longer the forgotten valve!.Arch Cardiovasc Dis. 2016; 109: 55-66
- National Trends and Outcomes in Isolated Tricuspid Valve Surgery.J Am Coll Cardiol. 2017; 70: 2953-2960
Article info
Publication history
Published online: September 26, 2018
Accepted:
September 17,
2018
Received in revised form:
September 13,
2018
Received:
August 13,
2018
Footnotes
The following authors have no conflicts of interest to declare: HK, JJP, DJC, DCL, RJL, DSP, LMC, JBS, CS, and RWY. Dr. Popma reports grants from Medtronic, Abbott Vascular, and Direct Flow Medical and personal fees from Boston Scientific, Cordis, and Direct Flow Medical, outside the submitted work. Dr. Cohen reports research grants from Edwards Lifesciences, Medtronic, Boston Scientific, and Abbott Vascular and personal fees from Edwards Lifesciences and Medtronic. Dr. Yeh reports investigator initiated grant funding from Abiomed, grant support from Boston Scientific, and consulting from Abbott, Medtronic, and Teleflex, outside the submitted work.
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