No longer the ‘forgotten valve’: Tricuspid valve surgery outcomes keep improving
Patient outcomes after tricuspid valve replacement (TVR) surgery have improved significantly over the years, according to new data published in The Annals of Thoracic Surgery.[1] The study’s authors reviewed more than two decades of data, highlighting the consistent reductions in operative mortality and severe complications.
“In the last several years, tricuspid valve disease has been increasingly recognized as an important clinical problem,” wrote first author Catherine Wagner, MD, an integrated cardiothoracic surgery resident at the University of Michigan, and colleagues. “Operative volume for tricuspid valve disease, and particularly TVR, has been increasing. Similarly, the transcatheter space has expanded into tricuspid interventions, and two transcatheter tricuspid valve devices are now approved by the U.S. Food and Drug Administration. Surgical teams are learning how to select and optimize patients before and after tricuspid valve surgery for optimal outcomes. In light of these changing practice patterns, it is unknown how current outcomes of tricuspid valve surgery compare to historic tricuspid valve surgery, when the tricuspid valve was the ‘forgotten valve.’”
Wagner et al. examined data from 250 TVR patients treated from 2000 to 2023 at a single institution. While 55% of patients were women, the median age was 57 years old. Patients were excluded if treated with a transcatheter procedure. All data came from the Society of Thoracic Surgeons Adult Cardiac Surgery Database.
Patients were split into three different eras. The first era included 84 patients who were treated from 2000 to 2013, the second era included 86 who were treated from 2014 to 2019 and the third era included 80 who were treated from 2020 to 2023.
The study’s primary outcome was a composite of major morbidity—including reoperation for cardiac purposes, renal failure, deep sternal wound infection, prolonged ventilation/intubation and cerebrovascular events—and operative mortality. Overall, that primary outcome occurred in 48% of patients during the first era, 38% of patients during the second era and then 21% of patients during the third era. The biggest improvement was seen in the prolonged ventilation rate, which dropped from 36% in the first era to 17% in the third era.
Operative mortality on its own, meanwhile, dropped from 8% during the first era to 6% during the third era.
After making certain risk adjustments, the authors found that patients in the third era had a 73% lower adjusted odds of morbidity/mortality than patients in the first era.
“Though there remain areas for improvement, the high-risk reputation of TVR may be changing in more recent surgical practices,” they wrote.
Wagner and colleagues noted that these improvements over time could be due in part to the fact that patients are being referred for treatment earlier now than they were in the past. Another factor to consider is the increased experience clinicians gained by performing TVR surgeries over the years.
“Likely, both factors have synergistically led to improved outcomes for patients undergoing TVR,” the group wrote. “Surgeons have developed greater scrutiny in patient selection as those with severe right ventricular failure and liver cirrhosis are not offered intervention, while preoperative admission for fluid optimization is commonly employed in these patients in the current era.”
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Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.