Outcomes of isolated tricuspid replacement versus repair among older patients with tricuspid regurgitation in the United States

Objective: Evidence is limited regarding early-term outcomes after isolated tricuspid operations for tricuspid regurgitation (TR). We compared the early-term outcomes after isolated tricuspid valve replacement versus repair using the contemporary data. Methods: We analyzed the national data on Medicare beneficiaries aged ≥65 years who underwent isolated tricuspid valve replacement or repair for TR between January 2016 and December 2020. The primary outcome was early-term (up to 3 years) all-cause mortality. The secondary outcomes included early-term major adverse cardiovascular events (MACE) and heart failure hospitalizations. MACE encompassed all-cause mortality, heart failure hospitalization, stroke, and tricuspid reoperations. A propensity score matching analysis was conducted to compare between replacement and repair. Results: A total of 1501 patients were included (replacement: 610 patients, repair: 891 patients). In the matched cohort (n = 547 in each group), the overall mortality and MACE were 39% and 46% at 3 years, respectively. Tricuspid valve replacement was associated with similar all-cause mortality in comparison to repair (adjusted hazard ratio [HR], 1.06; 95% confidence interval [CI], 0.86-1.30; P = .600). Similarly, the rates of MACE and heart failure hospitalizations were similar (adjusted HR, 1.01; 95% CI, 0.84-1.22, P = .910; subdistribution HR, 1.04; 95% CI, 0.72-1.49, P = .850, respectively) between these 2 procedures. Conclusions: Isolated surgical tricuspid valve replacement was associated with similar clinical outcomes compared to repair. Importantly, the high overall early-term mortality and morbidity with either treatment underscores the need for alternative intervention choices and further research to optimize the indication and timing of intervention.