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Cardiac surgery
Original research article
Comparative early outcomes of tricuspid Valve repair versus replacement for secondary tricuspid regurgitation
  1. Mohamad Alkhouli,
  2. Chalak Berzingi,
  3. Amer Kowatli,
  4. Fahad Alqahtani and
  5. Vinay Badhwar
  1. West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
  1. Correspondence to Dr Mohamad Alkhouli; adnanalkhouli{at}gmail.com

Abstract

Background Comparative outcome data on tricuspid valve repair (TVr) versus tricuspid valve replacement (TVR) for severe secondary tricuspid regurgitation (TR) are limited.

Methods We used a national inpatient sample to assess in-hospital morbidity and mortality, length of stay and cost in patients with severe secondary TR undergoing isolated TVr versus TVR.

Results A total of 1364 patients (national estimate=6757) underwent isolated tricuspid valve surgery during the study period, of whom 569 (41.7%) had TVr and 795 (58.3%) had TVR. There was no difference in the prevalence of major morbidities between the two groups, except for liver disease and hepatic cirrhosis, which were more common in the TVR group. Before propensity matching, in-hospital mortality was similar between patients who underwent isolated TVr and TVR (8.1% vs 10.8%, p=0.093), but the incidence of postoperative morbidities differed: TVR was associated with higher rates of permanent pacemaker implantation and blood transfusion, while TVr was associated with more acute kidney injury. After rigorous propensity score matching, TVR was associated with significantly higher rates of in-hospital death (12% vs 6.9%, p=0.009) and permanent pacemaker implantation (33.7% vs 11.2%, p<0.001). Postoperative morbidities and length of stay, however, were not different between the two groups. Nonetheless, cost of hospitalisation was 16% higher in the TVr group.

Conclusions In patients undergoing isolated surgery for secondary TR, TVR is associated with higher in-hospital mortality and need for permanent pacemaker compared with TVr. Further studies are needed to understand the impact of the type of surgery on the short-term and long-term mortality in this complex undertreated population.

  • tricuspid regurgitation
  • tricuspid valve repair
  • tricuspid valve replacement.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2018-000878

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    Footnotes

    • Contributors MA and CB planned the study and drafted the manuscript. AK and FA conducted the analysis. VB contributed to the study’s planning and made critical edits of the manuscript. MA is responsible for the overall content as the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The institutional review board approved the study and waived informed consent requirements because the data are derived from a nationwide deidentified database.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data used for this analysis will be available to other researchers upon request for the purpose of reproduction of the study’s results. No other unpublished data of this study are available.