Abstract 4139873: Isolated Tricuspid Replacement versus Repair among Medicare Beneficiaries

Background: Evidence is limited regarding mid-term outcomes following isolated tricuspid operations for tricuspid regurgitation at the population level. Objective: This study aimed to compare the mid-term outcomes following isolated tricuspid valve replacement versus repair using contemporary data. Methods: We analyzed the national data on Medicare beneficiaries aged ≥65 who underwent isolated tricuspid valve replacement or repair between January 2016 and December 2020. The primary outcome was mid-term (up to 3 years) all-cause mortality. The secondary outcomes included mid-term major adverse cardiovascular events (MACE) and heart failure hospitalizations, as well as in-hospital permanent pacemaker implantation rates. MACE comprised all-cause mortality, heart failure hospitalization, stroke, and tricuspid reoperations. A propensity score-matching analysis was conducted to compare the two groups. Results: A total of 1,693 patients were included (replacement= 655 patients, repair= 1,038 patients). In the matched cohort (597 patients in each group), the overall mortality and MACE were 40% and 47% at 3 years, respectively. Tricuspid valve replacement was associated with similar all-cause mortality in comparison to repair (adjusted hazard ratio [HR], 1.15; 95% confidence interval [CI], 0.95-1.39; P=0.15). Similarly, the rates of MACE and heart failure hospitalizations were similar (adjusted HR, 1.10; 95% CI, 0.93-1.32, P=0.27; subdistribution HR, 1.07, 95% CI, 0.75-1.54, P=0.69, respectively) between these two procedures. Patients undergoing replacement required permanent pacemaker implantations more frequently (25.4% vs. 12.4%; P<0.001). Conclusions: Isolated surgical tricuspid valve replacement was associated with similar clinical outcomes compared to repair, except for permanent pacemaker implantation rates. The overall high mid-term mortality and morbidity with either treatment highlight the need for better options and further research to optimize the indication and timing of intervention.