High Efficacy and Low Early Mortality in High-Volume Center Tricuspid Valve Surgery

Abstract

Background: Isolated tricuspid valve surgery has been associated with early mortality rates of up to 10%. With rapidly emerging interventional catheter-based options, the question arises of whether current technical and perioperative protocols in cardiac surgery might translate into lower than previously expected mortality rates, especially when looking at data from high-volume centers. Methods: We performed a retrospective single-center analysis in 369 patients undergoing isolated tricuspid valve repair (n=256) or replacement (n=113) between 2009 and 2021. Surgical approaches included full sternotomy, as well as right-sided mini-thoracotomy. According to a recently introduced clinical risk score (CRS), patients were divided into scoring groups and observed (O) versus expected (E) early mortality were compared. Pre- and postoperative tricuspid valve function was also analyzed. Results: Overall, 30-day mortality was 4.1%, ranging from 0% (scoring group 0-1 points) to 8.7% (scoring group ≥10 points), which was substantially lower than the expected early mortality (2% in the lowest to 34% in the highest scoring group). Preoperative tricuspid regurgitation was severe in 71.3% (n=263), moderate to severe in 14.9% (n=55), and mild or less in 6.5% (n=24). The corresponding postoperative values were 0% (n=0), 1.4% (n=5), and 81.6% (n=301). Conclusion: Our high-volume center data indicate substantially lower than predicted 30-day mortality in different cardiac surgical risk scoring groups. The majority of patients had zero to minimal residual tricuspid valve insufficiency postoperatively. Randomized controlled trials are needed to compare tricuspid valve functional results and long-term outcomes of surgical versus interventional procedures in patients undergoing isolated tricuspid valve procedures.