Isolated and Concomitant Tricuspid Valve Replacement: Long-Term Survival and Predictors of Mortality in a 25-Year Cohort

Background: Tricuspid valve replacement (TVR), particularly as an isolated procedure, is historically associated with high perioperative risk and poor outcomes. This study aimed to evaluate in-hospital and long-term outcomes of isolated versus concomitant TVR and identify predictors of morbidity/mortality in patients with severe tricuspid regurgitation (TR). Methods: This retrospective study included 245 consecutive adult patients who underwent surgical TVR at Beijing Anzhen Hospital between 1993 and 2019. Primary outcomes were in-hospital mortality and long-term survival. Univariate and multivariate logistic regression analyses were conducted to determine factors associated with in-hospital mortality, adjusting for chronic kidney disease (CKD) and TRI-SCORE. Additionally, univariate and multivariate Cox regression analyses were performed to identify factors associated with long-term mortality, adjusting for age, CKD, TRI-SCORE, and previous cardiac surgery history. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were utilized to adjust for baseline differences. Results: Patients were categorized into two groups: isolated TVR (n = 128) and concomitant TVR (n = 117). The mean age was 47 ± 13 years, 58.4% were male, and the mean left ventricular ejection fraction was 62 ± 10%. Isolated TVR patients had lower in-hospital mortality (7.8% vs. 17.9%; p = 0.017) compared to concomitant TVR patients. At 1, 5, and 10 years, the survival rates for isolated TVR were 89.1%, 83.3%, and 77.7%, respectively. For concomitant TVR, the corresponding rates were 72.6%, 68.9%, and 60.5%, respectively. Multivariate analysis identified isolated TVR as protective against in-hospital death (odds ratio (OR) = 0.40, 95% confidence interval (CI): 0.17–0.95; p = 0.037) and overall mortality (hazard ratio (HR) = 0.49, 95% CI: 0.30–0.81; p = 0.005). Additionally, TRI-SCORE and CKD were associated with in-hospital mortality, and both remained significant predictors of long-term mortality. IPTW and PSM analyses confirmed the results. Conclusions: Isolated TVR is associated with lower in-hospital and long-term mortality compared to concomitant TVR. Early referral before multivalve disease progression and meticulous patient selection—particularly avoiding advanced right-sided heart failure or renal dysfunction—may optimize outcomes. These findings advocate for timely isolated TVR in select TR patients to mitigate the compounding risks of delayed intervention.