Key result
Mitral and tricuspid repair linked to ~63% lower in-hospital mortality vs replacement in triple valve surgery.
Why the study?
Triple valve surgery remains a challenging procedure with limited literature regarding its contemporary prevalence, in-hospital outcomes, and prognostic determinants.
Observational (n=5,234)
Yes
Answers are grounded in this paper and cite their sources.
May support preferring repair over replacement in triple valve surgery; extends observational data but should not change practice without RCTs.
BACKGROUND: Triple valve surgery (TVS) remains a challenging procedure with limited existing literature. We aim to evaluate the prevalence, in-hospital outcomes, and prognostic determinants of TVS in the current era. MATERIALS AND METHODS: We reviewed the Nationwide Inpatient Sample database from 2003 to 2012 and included all patients who underwent aortic valve replacement (AVR) combined with mitral valve replacement (MVR) or repair (MVRep) and tricuspid valve replacement (TVR) or repair (TVRep). Logistic regression analysis was used to identify independent predictors of in-hospital mortality and propensity score matching was adopted to compare groups receiving different operations. RESULTS: Overall, 5234 patients were included. In-hospital mortality was 13.9%. Major adverse events occurred in 42.9% of the cases (44.9%, 40.3%, 44.4% and 74.2% in the AVR + MVR + TVR, AVR + MVR + TVRep, AVR + MVRep + TVRep and AVR + MVRep + TVR groups respectively, p < 0.05 for all intergroup comparisons). In-hospital mortality in the AVR + MVR + TVR, AVR + MVR + TVRep, AVR + MVRep + TVRep and AVR + MVRep + TVR groups was 19.9%, 13.3%, 12.9% and 0% respectively (p < 0.05 for all intergroup comparisons). At regression analysis, age, reoperation, and urgent/emergent operation were independent predictors of in-hospital mortality. Patients submitted to tricuspid valve repair and mitral and tricuspid repair had a 62% and 63% mortality risk reduction (OR:0.380, CI:0.19-0.76 p = 0.006 and OR:0.37, CI:0.18-0.78 p = 0.009 respectively). In the propensity matched comparisons, in-hospital mortality was statistically similar (p = 0.08 for AVR + MVR + TVR vs. AVR + MVR + TVRep comparison and p = 0.06 for AVR + MVR + TVR vs. AVR + MVRep + TVRep comparison). CONCLUSIONS: TVS is associated with significant in-hospital mortality and morbidity. The use of valve repair strategies for the mitral and tricuspid valves can positively impact postoperative outcomes.
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Ohmes et al. (2017) conducted an observational in Triple valve disease requiring triple valve surgery (n=5,234). Aortic valve replacement with mitral and tricuspid valve repair (AVR + MVRep + TVRep) vs. Triple valve replacement (AVR + MVR + TVR) was evaluated on In-hospital mortality (OR 0.37, 95% CI 0.18-0.78, p=0.009). Triple valve surgery had 13.9% in-hospital mortality, with mitral and tricuspid repair reducing mortality risk vs replacement (12.9% vs 19.9%; OR 0.37; 95% CI 0.18-0.78; P=0.009).
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