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Tricuspid Valve Replacement Across the Eras: Practice Patterns and Outcomes
Catherine M Wagner1, Leah Schoel2, Whitney Fu2
1Department of Cardiac Surgery, University of Michigan, Ann Arbor, Michigan.
Outcomes for surgical tricuspid valve replacement (TVR) have significantly improved. Major morbidity and mortality decreased, while midterm survival increased in recent years.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Outcomes Research
Background:
- Tricuspid valve replacement (TVR) historically carries high risks.
- Contemporary data on perioperative outcomes for TVR is limited.
- This study investigates trends in TVR outcomes over time.
Purpose of the Study:
- To evaluate the changes in major morbidity and operative mortality after surgical tricuspid valve replacement.
- To assess the trend of midterm survival rates following tricuspid valve replacement.
- To identify if outcomes for TVR have improved over recent years.
Main Methods:
- Retrospective review of 250 adult patients undergoing surgical TVR from 2000-2023.
- Patients were stratified into three eras: 2000-2013, 2014-2019, and 2020-2023.
- Primary outcome was a composite of major morbidity and operative mortality; multivariable logistic regression and Kaplan-Meier analysis were used.
Main Results:
- The composite outcome of major morbidity and operative mortality decreased significantly across eras (48% to 21%), largely due to reduced prolonged ventilation.
- Risk-adjusted outcomes showed a similar significant decrease (44% to 21%).
- Midterm (18-month) survival improved substantially from 63% in the earliest era to 82% in the most recent era.
Conclusions:
- Surgical tricuspid valve replacement outcomes have markedly improved in recent years.
- Major morbidity and mortality rates have decreased significantly.
- Midterm survival following TVR has shown a significant upward trend.
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