Long-term outcomes of isolated tricuspid surgery in 3706 patients: Implications for the future

Early and late outcomes of isolated tricuspid surgery in contemporary practice are poorly defined. This statewide analysis evaluated the early and late outcomes of isolated tricuspid repair and replacement.

From the Department of Health Care Access and Information of California State admissions database, 3706 patients who underwent isolated tricuspid repair (2419, 65.3%) or replacement (1287, 34.7%) between 1991 and 2020 were identified. Propensity score matching to adjust for 25 differences in baseline characteristics yielded 789 well-matched pairs. The primary outcome was all-cause mortality compared using Cox proportional hazards. The cumulative incidence of tricuspid reoperation and permanent pacemaker were compared in the Fine-Gray model with death as a competing risk. Median follow-up was 4.4 years (range, 0-30 years).

Isolated tricuspid operations increased from 48 in 1991 to 207 in 2021 (P < .001). Patients undergoing repair were similar in age (53.5 vs 54.5 years, P = .17), more often men (44% vs 40% P = .03), and less likely to have endocarditis (21.5% vs 26.8%, P = .002) compared with patients undergoing replacement. Operative mortality was similar between repair and replacement (8.2% vs 9.9%, P = .27), whereas pacemaker rates were higher after replacement (13.7% vs 32.3%, P < .001). Tricuspid repair was associated with reduced mortality at 25 years compared with replacement (58.1% vs 65.5%; hazard ratio, 0.81, 95% CI, 0.70-0.94, P = .005). The cumulative incidence of reoperation was lower with repair (5.6% vs 11.1%, hazard ratio, 0.57, 95% CI, 0.37-0.88, P = .01).

Tricuspid valve repair is associated with superior early and late outcomes compared with replacement in a statewide administrative dataset.