Elsevier

The Annals of Thoracic Surgery

Volume 96, Issue 5, November 2013, Pages 1546-1552
The Annals of Thoracic Surgery

Original article
Adult cardiac
Trends and Outcomes of Tricuspid Valve Surgery in North America: An Analysis of More Than 50,000 Patients From The Society of Thoracic Surgeons Database

Presented at the Forty-ninth Annual Meeting of The Society of Thoracic Surgeons, Los Angeles, CA, Jan 26–30, 2013.
https://doi.org/10.1016/j.athoracsur.2013.06.031Get rights and content

Background

This study evaluated trends and outcomes of tricuspid valve surgery (TVS) in North America over the past decade.

Methods

Adults undergoing TVS between 2000 and 2010 were identified in The Society of Thoracic Surgeons (STS) National Database. Trends were evaluated using linear regression. Multivariable logistic regression analysis was conducted using covariates from the STS valve risk model to identify significant predictors of operative mortality.

Results

A total of 54,375 patients underwent TVS during the study period. The majority of cases were repairs (89%; n = 48,322) and were performed concomitant with another major procedure (86%; n = 46,593). The proportion of TVS that were repairs increased from 84.6% in 2000 to 89.8% in 2010 (p = 0.01). Trend analysis revealed significant changes in patient characteristics with time, including increasing age, a higher comorbidity burden, and a higher proportion of emergency cases. Despite worsening risk factors, unadjusted operative mortality for TVS declined from 10.6% in 2000 to 8.2% in 2010 (p < 0.001), and this trend persisted after risk adjustment. In the multivariable model, concomitant procedures involving multiple valves or coronary artery bypass grafting were associated with an increased risk of mortality compared with isolated TVS, although other factors including renal failure, congestive heart failure, nonelective presentation, reoperation, and tricuspid valve replacement exerted equal or stronger effects.

Conclusions

During the past decade, repair rates for TVS have increased significantly. Although patients undergoing TVS have demonstrated worsening risk factors, unadjusted and adjusted operative mortalities have declined. Finally, the data suggest that tricuspid valve repair when technically feasible, together with early elective surgical intervention, should be emphasized as potential candidates for continued outcome improvement.

Section snippets

Study Population

All adult patients 18 years or older undergoing TVS between January 1, 2000, and December 31, 2010, were identified in the STS Adult Cardiac Surgery Database. As this registry contains deidentified data with no direct patient identifiers and was originally collected for non-research purposes, the Duke University Health System Institutional Review Board deemed this research exempt from review as it does not qualify as human subjects research [1].

Outcomes

The primary outcome was operative mortality, which

Trends in Patient Characteristics

A total of 54,375 TVS were identified during the study period. The mean age of patients increased significantly from 63.6 ± 14.4 years in 2000 to 64.9 ± 14.9 years in 2010 (p < 0.001; Table 1). When examined as a categorical variable, the percentage of patients 75 years or older increased from 25.0% to 31.4% during the study period. The proportion of women decreased significantly, from 64.6% to 58.2% of the study cohort (p < 0.0001). With respect to comorbidities, the rates of diabetes

Study Findings

In this study we used the STS Adult Cardiac Surgery Database to examine trends and outcomes of TVS In North America. An important finding was that the proportion of tricuspid valve annuloplasties increased significantly during the study period, whereas the proportion of tricuspid valve replacements decreased. Prior data have demonstrated that tricuspid valve repair is associated with improved perioperative and longer-term survival as compared with replacement [4]. It is unclear which specific

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Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.