Isolated Tricuspid Valve Repair Versus Replacement: Predictors of Mortality on the National Level

被引:8
作者
Alnajar, Ahmed [1 ]
Arora, Yingyot [1 ]
Benck, Kelley N. N. [1 ]
Khan, Abdul Kabir [1 ]
Altabbakh, Omar [2 ]
Dar, Tawseef [1 ]
Lamelas, Joseph [1 ,3 ]
机构
[1] Univ Miami, DeWitt Daughtry Dept Surg, Div Cardiothorac Surg, Miller Sch Med, Miami, FL 33125 USA
[2] Nova Southeastern Univ, Clearwater, FL USA
[3] Univ Miami, Div Cardiothorac Surg, 1400 NW 12th St,Suite 1, Miami, FL 33125 USA
关键词
tricuspid valve replacement; tricuspid valve repair; outcomes; short-term mortality predictors; disparities; OUTCOMES; DISEASE;
D O I
10.1177/15569845231153127
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Isolated tricuspid valve surgery (TVR) is rarely performed, and literature reports are confined to small sample sizes and old studies. Thus, the advantage of repair over replacement could not be determined. We aimed to evaluate repair and replacement outcomes along with predictors of mortality for TVR on a national level. Methods: All adult patients (18+ years old) who underwent TVR from 2011 to 2020 were identified using the National Inpatient Sample dataset. The primary outcome was in-hospital mortality. Secondary outcomes included complications, length of stay (LOS), hospitalization cost, and discharge disposition. Results: Over a 10-year period, 37,931 patients had TVR and predominantly underwent repair (n = 25,027, 66.0%). In comparison with patients who underwent tricuspid replacement, more patients with a history of liver disease and pulmonary hypertension presented for repair surgery, and fewer patients had endocarditis and rheumatic valve disease (P < 0.001). The repair group had less mortality, less stroke, shorter LOS, and reduced cost, while the replacement group had fewer myocardial infarctions (P < 0.05). However, the outcomes were not different for cardiac arrest, wound complications, or bleeding. After excluding congenital TV disease and adjusting for relevant factors, TV repair was associated with a reduced in-hospital mortality by 28% (adjusted odds ratio [aOR] = 0.72, P = 0.011). Older age increased mortality risk by 3-fold, prior stroke by 2-fold, and liver diseases by 5-fold (P < 0.001). Patients undergoing TVR in recent years had a better chance of survival (aOR = 0.92, P < 0.001). Conclusions: TV repair has better outcomes than replacement does. Patient comorbidities and late presentation play an independently significant role in determining outcomes.
引用
收藏
页码:58 / 66
页数:9
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