Original Investigation
National Trends and Outcomes in Isolated Tricuspid Valve Surgery

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Abstract

Background

Severe isolated disease of the tricuspid valve (TV) is increasing and results in intractable right heart failure. However, isolated TV surgery is rarely performed, and there are little data describing surgical outcomes.

Objectives

The purpose of this study was to evaluate contemporary utilization trends and in-hospital outcomes for isolated TV surgery in the United States.

Methods

Patients age >18 years who underwent TV repair or replacement from 2004 to 2013 were identified using the National Inpatient Sample. Patients with congenital heart disease, with endocarditis, and undergoing concomitant cardiac operations except for coronary bypass surgery were excluded.

Results

Over a 10-year period, a total of 5,005 isolated TV operations were performed nationally. Operations per year increased from 290 in 2004 to 780 in 2013 (p < 0.001 for trend). In-hospital mortality was 8.8% and did not vary across the study period. Adjusted in-hospital mortality for TV replacement was significantly higher than TV repair (odds ratio: 1.91; 95% confidence interval: 1.18 to 3.09; p = 0.009).

Conclusions

Isolated TV surgery is rarely performed, although utilization has increased over time. However, despite an increase in surgical volume, operative mortality has not changed. Mortality is greatest in patients undergoing valve replacement. Given the increasing prevalence of isolated TV disease in the population, research into optimal surgical timing and patient selection is critical.

Key Words

isolated tricuspid valve disease
national inpatient sample
tricuspid regurgitation
tricuspid valve repair
tricuspid valve replacement

Abbreviations and Acronyms

CABG
coronary artery bypass graft surgery
CI
confidence interval
ICD-9-CM
International Classification of Diseases-9th Revision-Clinical Modification
IQR
interquartile range
NIS
National Inpatient Sample
TR
tricuspid regurgitation
TV
tricuspid valve

Cited by (0)

This publication was made possible by funding from the National Institutes of Health CTSA grant number UL1 TR000135 from the National Center for Advancing Translational Sciences and grant number P50 AG044170 (to Dr. Miller). The contents of this paper are solely the responsibility of the authors and do not necessarily represent the official view of the National Institutes of Health. The authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Zack and Fender contributed equally to this work and are joint first authors.

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