Key result
In-hospital mortality for tricuspid valve surgery was similar between patients with a prior orthotopic heart transplant and those with native hearts (7% vs. 8%, p=0.753).
Why the study?
Tricuspid regurgitation is common after orthotopic heart transplant, but data on tricuspid valve surgery in this population are limited.
Does tricuspid valve surgery in orthotopic heart transplant patients have different in-hospital outcomes compared to native heart patients?
Observational (n=42,766)
Yes
Does tricuspid valve surgery in orthotopic heart transplant patients have different in-hospital outcomes compared to native heart patients?
Absolute Event Rate: 7% vs 8%
p-value: p=0.753
Tricuspid valve surgery in heart transplant recipients carries a similar in-hospital mortality to native heart patients, despite higher rates of postoperative complications like cardiogenic shock and AKI.
Tricuspid valve surgery shows comparable mortality in OHT versus native hearts; leaves open whether higher shock and AKI rates warrant tailored perioperative protocols.
Introduction: Tricuspid valve (TV) regurgitation is the most common valvular pathology after orthotopic heart transplant (OHT). The number of transplants being performed is increasing with patients living longer after heart transplant. Data on TV surgery in OHT recipients is limited. Methods: We sought to analyze the outcomes of patients undergoing TV surgery from a large diverse, multicentric, nationwide cohort using the Nationwide Inpatient Sample (NIS) database. Results:A total of 42,766 TV repair or replacement (bioprosthetic and mechanical) involving adult patients (age ≥18 years) between 2007 and September 2015 were identified. Of these, 366 were performed in patients with OHT. TV repair was the most common surgery performed in both groups (OHT group and native heart group). Compared to the native group, patients with OHT had a significantly higher incidence of cardiogenic shock (20 vs. 11%, p = 0.024), acute kidney injury (AKI) (59 vs. 30%, p < 0.001), and AKI requiring hemodialysis (13 vs. 4%, p < 0.001). Also, the mean length of stay for the index admission was significantly longer in the OHT group (27 vs. 17 days, p = 0.008). The mortality rate was similar between the two groups (7 vs. 8%, p = 0.753). The number of TV surgeries performed in OHT patients from 2007 to 2014 have remained stable (p = 0.803) compared to those in native heart patients which showed a significantly increasing trend (p = 0.019) during the same time period. Conclusions: TV surgery remains an important treatment modality among the OHT population and carries a similar mortality during index hospitalization as that in native heart patients undergoing TV surgery.
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Mohammed et al. (2020) conducted an observational in Tricuspid valve regurgitation requiring surgery (n=42,766). Prior orthotopic heart transplant (OHT) vs. Native heart (no prior OHT) was evaluated on In-hospital mortality (p=0.753). In-hospital mortality for tricuspid valve surgery was similar between patients with a prior orthotopic heart transplant and those with native hearts (7% vs. 8%, p=0.753).
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