Isolated tricuspid valve surgery–impact of etiology and clinical presentation on outcomes

Aims To identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) as little is known regarding the impact of tricuspid regurgitation (TR) mechanism and clinical presentation. Methods and results Among 5661 consecutive adult patients who underwent a tricuspid valve surgery at 12 French tertiary centers in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease (47% in NYHA III/IV, 57% with right-sided heart failure (HF) signs). TR was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31% respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14.4% vs. 6.3%, P = 0.004) but presentation was more severe. Independent determinants of outcomes were NYHA class III/IV (OR = 2.7[1.2–6.1], P = 0.01), moderate/severe right ventricular dysfunction (OR = 2.6[1.2–5.8], P = 0.02), lower prothrombin time (OR = 0.98[0.96–0.99], P = 0.008) and with borderline statistical significance, right-sided HF signs (OR = 2.4[0.9–6.5], P = 0.06) while TR mechanism was not (OR = 0.7[0.3–1.8], P = 0.88). Conclusion ITVS was associated with high mortality and morbidity, both in-hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.