Association of Predicted Surgical Risk With 3-Year Outcomes After Isolated Tricuspid Valve Surgery: An Analysis of Medicare Beneficiaries.
Abstract
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.