Trends and outcomes of concomitant tricuspid valve surgery with mitral valve surgery: A National Readmission Database study.

Background: Clinically significant tricuspid regurgitation (TR) affects nearly one-third of patients with mitral valve (MV) disease and portends higher morbidity and mortality. Concomitant tricuspid valve repair (TVr) is recommended during MV surgery (MVS) for patients with severe TR or moderate TR with tricuspid annular dilation or right-sided heart failure. This study assessed the frequency, trends, and outcomes of concomitant tricuspid valve surgery (TVS) in MVS patients in the United States.

Methods: We analyzed index hospitalizations of patients undergoing MVS from the 2016-2020 Nationwide Readmissions Database (NRD), stratified by whether concomitant TVS was performed. Outcomes included inpatient mortality, length of stay (LOS), post-operative complications, and 30-day and 90-day all-cause readmissions. Inverse probability of treatment weighting (IPTW) controlled for selection bias. Outcomes were assessed using logistic regression and lognormal models.

Results: Out of 63,047 weighted hospitalizations for MVS, 2627 (4.17 %) underwent concomitant TVS. TVS was associated with 67 % higher adjusted odds of in-hospital mortality (8.29 % vs. 5.14 %, aOR 1.67; 95 % CI: 1.33-2.10; p < 0.001) and 61 % higher odds of complications (40.94 % vs. 30.08 %, aOR 1.61; 95 % CI: 1.42-1.83; p < 0.001) compared to MVS alone. TVS was associated with 18 % longer hospital stay (12.17 days vs. 10.27 days, aOR 1.18; 95 % CI: 1.13-1.24) and higher odds of 90-day readmission (30.26 % vs. 25.58 %, aOR:1.26;95 % CI: 1.06-1.50).

Conclusions: Concomitant tricuspid valve surgery in patients undergoing mitral valve surgery is associated with higher in-hospital mortality, complications, and readmissions. This early excess risk has to be weighed against potential long-term benefits.