From 2018-2023 in Germany, TTVI procedures increased rapidly with 1.4% in-hospital mortality, while TVS decreased with 14.1% mortality and longer hospital stays.
What are the trends, indications, and in-hospital mortality rates of transcatheter tricuspid valve interventions compared to tricuspid valve surgery in patients with tricuspid valve disease?
Transcatheter tricuspid valve interventions have rapidly increased in Germany from 2018 to 2023, offering a lower in-hospital mortality alternative to surgery, particularly for isolated tricuspid regurgitation, while surgery remains crucial for endocarditis and multiple valve disease.
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Abstract Background Tricuspid valve diseases are common and associated with high morbidity and mortality. In recent years, new interventional therapies (TTVI) have been developed, as many patients are not suitable for surgical procedures (TVS) due to age or comorbidities. Purpose The current analysis aims to provide a comprehensive overview of recent trends in TTVI and TVS for tricuspid valve disease. Methods Analysis of diagnosis related groups (DRG), including OPS (operation and procedure codes) and ICD (international classification of diseases) codes, from 2018 to 2023 from the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Federal States, Berlin, Germany, were retrospectively included (source from DOI: 10.21242/23141.2023.00.00.1.1.0, 10.21242/23141.2022.00.00.1.1.0, 10.21242/23141.2021.00.00.1.1.0, 10.21242/23141.2020.00.00.1.1.0, 10.21242/23141.2019.00.00.1.1.1, 10.21242/23141.2018.00.00.1.1.0, own calculations). Patients with tricuspid disease, including tricuspid regurgitation (TR), stenosis (TS), and infective endocarditis (IE), who underwent TVS or TTVI were enrolled. Patients under 18 years of age and those with congenital heart valve disease were excluded. Endpoints comprised the number of performed procedures, indications, in-hospital mortality, and risk factors. Results A total of 17,246 patients were enrolled in the current analysis, including 6,369 TVS and 10,877 TTVI. Patients who underwent a TVS were younger 69 (59-76) years vs. 81 (77-84) years and less often female (44% vs. 59%) compared to TTVI. Indications for TVS comprised 33% TR, 1% TS, 1% combined TR and TS, 34% IE, 31% multiple valve disease, and 1% other, not-specified tricuspid valve diseases, while indications for TTVI included 98% TR, 1% TS, 0.3% combined TR and TS, 0.1% IE, 0.8% multiple valve disease, and 0.2% other, not-specified tricuspid valve diseases. TVS was combined with further surgical procedures in 1,842 patients (29%). From 2018 to 2023 the number of performed TTVI increased rapidly, whereas the number of TVS decreased (Figure 1). The median length of hospital stay was 17 (12-28) days after TVS and 7 (5-11) days after TTVI (p0.001). In the observed reporting period, a total of 1051 in-house mortality cases were recorded, with 900 (14.1%) attributable to TVS and 151 (1.4%) to TTVI. The following comorbidities were identified as risk factors for in-hospital mortality after TVS and TTVI: chronic kidney disease, liver cirrhosis, previous coronary bypass grafting, and prior cardiac surgery. The presence of a cardiac implantable electronic device was a risk factor after TVS, while diabetes and chronic obstructive pulmonary disease were risk factors after TTVI. Conclusion The analysis shows the rapid increase in TTVI over a period of six years. At the same time, TVS remain an important treatment option for multiple valve disease and IE.
Mattig et al. (Sat,) reported a other. From 2018-2023 in Germany, TTVI procedures increased rapidly with 1.4% in-hospital mortality, while TVS decreased with 14.1% mortality and longer hospital stays.