National Trends and Outcomes in Isolated Tricuspid Valve Surgery

J Am Coll Cardiol. 2017 Dec 19;70(24):2953-2960. doi: 10.1016/j.jacc.2017.10.039.


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.

Keywords: isolated tricuspid valve disease; national inpatient sample; tricuspid regurgitation; tricuspid valve repair; tricuspid valve replacement.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Cardiac Surgical Procedures / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Forecasting*
  • Heart Valve Diseases / epidemiology
  • Heart Valve Diseases / surgery*
  • Hospital Mortality / trends
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Outcome Assessment, Health Care / trends*
  • Postoperative Complications / epidemiology*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • Survival Rate / trends
  • Time Factors
  • Treatment Outcome
  • Tricuspid Valve / surgery*
  • United States / epidemiology