Tricuspid Valve Replacement Across the Eras: Practice Patterns and Outcomes.

Abstract

Patients undergoing tricuspid valve replacement (TVR) historically have high mortality and morbidity, although there are limited contemporary reports of perioperative outcomes. We hypothesized that outcomes of patients undergoing TVR have improved over time. A retrospective review of adult patients undergoing surgical TVR from 2000 to 2023 at a single center was performed. TVRs were split by surgery year into 3 eras: era 1 (2000-2013), era 2 (2014-2019), and era 3 (2020-2023). Isolated and concomitant TVR were both included. Transcatheter TVR was excluded. The primary outcome was a composite of major morbidity and operative mortality. Multivariable logistic regression was performed to identify predictors of the primary outcome, incorporating age, comorbidities, and surgery era. Kaplan-Meier analysis characterized long-term survival. TVR was performed in 250 patients, and 138 (55%) were women, with a median age of 57 years (interquartile range, 42-69) years. Patients in the later eras had lower New York Heart Association Functional Classification and were more likely to have an elective operation than in the earliest era. The composite outcome decreased throughout the surgery eras (era 1: 48% [n = 40]; era 2: 38% [n = 33]; and era 3: 21% [n = 17]; P = .002), but this was driven largely by decreased prolonged ventilation. This pattern persisted after risk adjustment (era 1: 44% [95% CI, 34%-54%]; era 2: 41% [95% CI, 31%-51%]; and era 3: 21% [95% CI, 12%-30%], P = .003). Midterm (18-month) survival increased from 63% (95% CI, 52%-73%) in era 1 to 82% (95% CI, 70%-89%) in era 3 (P < .001). In the most recent years, major morbidity and mortality after surgical TVR has decreased, and midterm survival increased significantly. Outcomes for TVR have improved in recent years.