Late outcomes of valve repair versus replacement in isolated and concomitant tricuspid valve surgery: A nationwide cohort study

BACKGROUND: Surgery for tricuspid valve (TV) diseases is associated with poor prognosis, but few studies have described the long-term outcomes by comparing TV repair and replacement in isolated and concomitant TV surgeries separately. METHODS AND RESULTS: Between 2000 and 2013, adult patients who underwent TV repair or replacement surgeries were identified from the Taiwan National Health Insurance Research Database. Outcomes of interest included all-cause mortality, composite outcome, and readmission attributable to any cause. Inverse probability of treatment weighting was used to reduce confounding effects. A total of 2644 patients with a mean follow-up of 4.9 years were included. Of them, 12.6% and 87.4% underwent isolated and concomitant TV surgery, respectively. The in-hospital mortality rates for isolated and concomitant TV surgery were 8.7% and 8.6%, respectively, whereas all-cause mortality rates were 41.7% and 36.8%, respectively. Compared with TV replacement, TV repair demonstrated significantly lower risks of all-cause mortality (concomitant: hazard ratio [HR], 0.76; 95% CI, 0.59–0.99), composite outcome (isolated: subdistribution HR, 0.55; 95% CI, 0.35–0.89; concomitant: subdistribution HR, 0.63; 95% CI, 0.46–0.86), and readmission (isolated: subdistribution HR, 0.64; 95% CI, 0.46–0.91; concomitant: subdistribution HR, 0.72; 95% CI, 0.60–0.86), except insignificant difference in all-cause mortality in isolated surgery. CONCLUSIONS: Compared with replacement, TV repair is associated with better short-and long-term outcomes in both isolated and concomitant TV surgery. However, further prospective clinical trials are warranted.