Abstract
BACKGROUND: Despite the increasing prevalence of tricuspid valve (TV) regurgitation, surgical interventions remain low, potentially due to high operative mortality. Given the lack of contemporary data, we examined trends in utilization and outcomes after isolated and concomitant TV operations. METHODS: Adults undergoing TV repair/replacement were identified in the 2016-2021 National Inpatient Sample. Patients undergoing heart transplantation, ventricular assist device placement, or with endocarditis were excluded. Study cohorts were stratified based on Isolated vs concomitant TV surgery (TV-Mitral, TV-Aortic, TV-coronary artery bypass grafting [CABG]). Multivariable mixed regressions were developed to evaluate the association of concomitant surgery with major adverse events including mortality and complications, costs, and length of stay. RESULTS: Of 51,940 patients, 19.2% underwent Isolated TV, 47.2% TV-Mitral, 14.6% TV-Aortic, and 19.0% TV-CABG operations. The volume of Isolated TV procedures significantly increased from 1415 in 2016 to 1830 in 2021 (P = .001). Compared with Isolated TV, patients undergoing concomitant operations were older with greater burden of comorbidities. TV-CABG and TV-Aortic patients experienced higher major adverse event rates of 67.6% and 56.5%, respectively, compared with 46.1% and 50.1% among TV-Mitral and Isolated TV (P < .001). Furthermore, TV-CABG and TV-Aortic cohorts experienced greater length of stay, costs, and nonhome discharge relative to TV-Mitral and Isolated TV, which were comparable. After adjustment, major adverse event rates significantly decreased over time among TV-CABG and remained stable among all other groups. CONCLUSIONS: Utilization of isolated tricuspid surgery is rising, with comparable complications and resource use relative to concomitant mitral operations. Given the lack of improvement in postoperative morbidity over time, further optimization of tricuspid surgical timing is warranted.