Prevalence and Outcomes of Isolated Tricuspid Valve Surgery Among Medicare Beneficiaries

Kundi, Harun; Popma, Jeffrey J.; Cohen, David J.; Liu, David C.; Laham, Roger J.; Pinto, Duane S.; Chu, Louis M.; Strom, Jordan B.; Shen, Changyu; Yeh, Robert W.

doi:10.1016/j.amjcard.2018.09.016

Cited by 50 publications

(31 citation statements)

References 25 publications

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“…Finally, age was identified as the only independent variable associated with in‐hospital mortality. This observation is consistent with previous articles 8,16,17 and emphasizes the concept that the outcome of isolated TV surgery seems mainly dictated by the preoperative characteristics rather than the surgical technique. Prompt surgical referral should be strongly encouraged to improve the overall outcomes of TV surgery 8,26 …”

Section: Discussionsupporting

confidence: 93%

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Flagiello¹,

Grinberg

Connock

et al. 2021

J Card Surg

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Background and aim of the study Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. Methods We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross‐clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in‐hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity‐score matching. Results From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In‐hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36–10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36–9.97). Age was the only predictor of in‐hospital mortality. Conclusions The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.

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Section: Discussionsupporting

confidence: 93%

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Flagiello¹,

Grinberg

Connock

et al. 2021

J Card Surg

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“…Compared with data from the Society of Thoracic Surgeon’s Database, this mortality is much higher versus the 2%–3% mortality for isolated aortic and mitral valve surgeries5 and is more comparable to endocarditis surgery that has a reported risk of 8.2% 14. Possible factors contributing to the high risk of isolated tricuspid valve surgery include high prevalence of previous cardiac surgery, atrial fibrillation, heart failure, right ventricular dilation and/or dysfunction, pulmonary hypertension, non-cardiac comorbidities and late presentation for surgery 6 17. Long-term mortality was less often reported and no differences by type of operation were seen in our analysis.…”

Section: Discussionmentioning

confidence: 84%

“…A total of 811 entries were obtained from the literature search, and figure 1 summarises the studies disposition. After abstract screening, 54 full-text studies were evaluated before arriving at the final 16 studies that met the inclusion criteria of this meta-analysis 6–21Table 1. lists the main characteristics of the included studies, totalling 6808 isolated tricuspid valve repairs and 8261 isolated tricuspid valve replacement patients.…”

Section: Resultsmentioning

confidence: 99%

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

et al. 2020

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ObjectivesTricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical approach in isolated tricuspid valve disease. We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.MethodsWe searched Pubmed, Embase, Scopus and Cochrane from January 1980 to June 2019 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software.ResultsThere were 811 article abstracts screened, from which 52 full-text articles reviewed and 16 studies included, totalling 6808 repairs and 8261 replacements. Mean age ranged from 36 to 68 years and females made up 24%–92% of these studies. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs 21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63 (1.10 to 2.41). There were no differences in rates of prolonged ventilation, mediastinitis, return to operating room or late mortality.ConclusionIsolated tricuspid valve repair was associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease, although its higher stroke rate warrants further research.

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“…Structured echocardiographic report data from 167,368 TTEs on 75,681 individuals �65 years old, 1/1/2000-9/20/2018, at Beth Israel Deaconess Medical Center (BIDMC) were directly linked to 100% Medicare inpatient discharge claims, 2003-2017, in the Medicare Provider Analysis and Review dataset. The Medicare Provider Analysis and Review dataset represents a complete sample of Part A hospitalization discharge claims on Medicare Fee-for-service beneficiaries and has been used extensively to study health outcomes [24][25][26][27]. Only the first sequential TTE was considered for the current analysis.…”

Section: Study Populationmentioning

confidence: 99%

Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience

Hammond

Shen

et al. 2020

PLoS ONE

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Background Limited data exist on the differential ability of variables on transthoracic echocardiogram (TTE) to predict heart failure (HF) readmission across the spectrum of left ventricular (LV) systolic function. Methods We linked 15 years of TTE report data (1/6/2003-5/3/2018) at Beth Israel Deaconess Medical Center to complete Medicare claims. In those with recent HF, we evaluated the relationship between variables on baseline TTE and HF readmission, stratified by LVEF. Results After excluding TTEs with uninterpretable diastology, 5,900 individuals (mean age: 76.9 years; 49.1% female) were included, of which 2545 individuals (41.6%) were admitted for HF. Diastolic variables augmented prediction compared to demographics, comorbidities, and echocardiographic structural variables (p < 0.001), though discrimination was modest (c-statistic = 0.63). LV dimensions and eccentric hypertrophy predicted HF in HF with reduced (HFrEF) but not preserved (HFpEF) systolic function, whereas LV wall thickness, NT-proBNP, pulmonary vein D- and Ar-wave velocities, and atrial dimensions predicted HF in HFpEF but not HFrEF (all interaction p < 0.10). Prediction of HF readmission was not different in HFpEF and HFrEF (p = 0.93). Conclusions In this single-center echocardiographic study linked to Medicare claims, left ventricular dimensions and eccentric hypertrophy predicted HF readmission in HFrEF but not HFpEF and left ventricular wall thickness predicted HF readmission in HFpEF but not HFrEF. Regardless of LVEF, diastolic variables augmented prediction of HF readmission compared to echocardiographic structural variables, demographics, and comorbidities alone. The additional role of medication adherence, readmission history, and functional status in differential prediction of HF readmission by LVEF category should be considered for future study.

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Prevalence and Outcomes of Isolated Tricuspid Valve Surgery Among Medicare Beneficiaries

Cited by 50 publications

References 25 publications

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

Retrospective evaluation of echocardiographic variables for prediction of heart failure hospitalization in heart failure with preserved versus reduced ejection fraction: A single center experience

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