Key result
High predicted surgical risk is linked to ~42% lower 3-year survival after tricuspid surgery.
Why the study?
Understanding long-term outcomes of isolated tricuspid valve surgery is increasingly relevant with recent approval of transcatheter tricuspid valve interventions for high surgical risk patients.
Does predicted surgical risk associate with 3-year outcomes and healthcare costs after isolated tricuspid valve surgery in Medicare beneficiaries?
Cohort (n=3,437)
Yes
Does predicted surgical risk associate with 3-year outcomes and healthcare costs after isolated tricuspid valve surgery in Medicare beneficiaries?
Absolute Event Rate: 49.6% vs 84.9%
p-value: p=<0.001
In Medicare beneficiaries undergoing isolated tricuspid valve surgery, predicted operative mortality strongly correlates with 3-year survival and heart failure readmissions, providing a benchmark for emerging transcatheter therapies.
Offers Medicare benchmark for isolated TV surgery outcomes and costs; leaves open comparative effectiveness with transcatheter therapies.
BACKGROUND: With recent approval of transcatheter tricuspid valve (TV) interventions for high/prohibitive surgical risk patients, understanding the long-term outcomes of isolated TV surgery has become increasingly relevant. OBJECTIVES: The objective of the study was to evaluate longitudinal outcomes and health care costs of isolated surgical TV surgery to provide a potential benchmark for emerging transcatheter therapies. METHODS: Using the U.S. fee-for-service Medicare database, we evaluated longitudinal outcomes of all beneficiaries undergoing isolated TV repair or replacement (TVR) from 2018 to 2022. Patients with endocarditis were excluded. A claims-based, frailty-inclusive multivariable logistic regression model of predicted in-hospital mortality was developed (optimism-corrected area under the receiver-operating characteristic curve = 0.870). Patients were stratified by low (<4%), intermediate (4% to 8%), or high (>8%) predicated risk of surgical mortality. Kaplan-Meier and Fine Gray methods were used for time to event analysis. RESULTS: A total of 3,437 patients underwent isolated TVR (n = 1,285) or TV repair (n = 2,152). In-hospital mortality was higher for TVR (8.1% vs 5.3%; P = 0.001). Most patients (71.0%) were low risk, 9.0% intermediate, and 20.0% high risk. Three-year survival was significantly higher in the low (84.9%) and intermediate (66.5%) risk groups compared to high risk (49.6%), P < 0.001. Heart failure readmission-free survival correlated with predicted risk whereas valve reintervention was low in all groups (2.5% at 3 years). Index hospitalization costs increased with predicted risk. CONCLUSIONS: In Medicare beneficiaries undergoing isolated TV surgery, predicted operative mortality was associated with 3-year survival, heart failure readmission, and health care costs. These contemporary real-world data may inform heart team discussions and future trial designs for emerging transcatheter therapies.
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Mehaffey et al. (2026) conducted a cohort in Isolated tricuspid valve surgery (n=3,437). High predicted surgical risk (>8%) vs. Low predicted surgical risk (<4%) was evaluated on 3-year survival (p=<0.001). High predicted surgical risk was associated with significantly lower 3-year survival compared to low predicted risk (49.6% vs 84.9%, P<0.001) after isolated tricuspid valve surgery.
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