Comparison of outcomes between transcatheter tricuspid valve repair and surgical tricuspid valve replacement or repair in patients with tricuspid insufficiency

Abstract

Background Tricuspid regurgitation is associated with significant morbidity and mortality, but with limited treatment options. The objective of this study is to compare the demographic characteristics, complications, and outcomes of transcatheter tricuspid valve repair (TTVr) versus surgical tricuspid valve replacement (STVR) or surgical tricuspid valve repair (STVr), using real-world data from the National Inpatient Sample (NIS) database. Methods and results Our study analyzed data from the National Inpatient Sample (NIS) database from 2016 to 2018 and identified 92, 86, and 84 patients with tricuspid insufficiency who underwent STVr, STVR, and TTVr, respectively. The mean ages of patients who received STVr, STVR, and TTVr were 65.03 years, 66.3 years, and 71.09 years, respectively, with TTVr patients significantly older than those who received STVr (P < 0.05). Patients who received STVr or STVR had higher mortality rates (8.7% and 3.5%, respectively) compared to those who received TTVr (1.2%). Patients who underwent STVr or STVR were also more likely to experience perioperative complications, including third-degree atrioventricular block (8.7% STVr vs. 1.2% TTVr, P = 0.329; 38.4% STVR vs. 1.2% TTVr, P < 0.05), respiratory failure (5.4% STVr vs. 1.2% TTVr, P = 0.369; 15.1% STVR vs. 1.2% TTVr, P < 0.05), respiratory complications (6.5% STVr vs. 1.2% TTVr, P = 0.372; 19.8% STVR vs. 1.2% TTVr, P < 0.05), acute kidney injury (40.2% STVr vs. 27.4% TTVr, P = 0.367; 34.9% STVR vs. 27.4% TTVr, P = 0.617), and fluid and electrolyte disorders (44.6% STVr vs. 22.6% TTVr, P = 0.1332; 50% STVR vs. 22.6% TTVr, P < 0.05). In addition, the average cost of care and the average length of hospital stay were higher for patients who underwent STVr or STVR than for those who received TTVr (USD$37995 ± 356008.523 STVr vs. USD$198397 ± 188943.082 TTVr, P < 0.05; USD$470948 ± 614177.568 STVR vs. USD$198397 ± 188943.082 TTVr, P < 0.05; 15.4 ± 15.19 STVr vs. 9.6 ± 10.21 days TTVr, P = 0.267; 24.7 ± 28.81 STVR vs. 9.6 ± 10.21 days TTVr, P < 0.05). Conclusion TTVr has shown to have favorable outcomes compared to STVr or STVR, but more research and clinical trials are required to help formulate evidence-based guidelines for the role of catheter-based management in tricuspid valve disease.

The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association

“…65 It is notable that, compared with patients who are treated with transcatheter tricuspid therapies, patients treated with TV surgery are significantly younger. 66 Long-term survival and durability data remain rather limited, likely because of limited follow-up in this cohort. A team-based approach to the preoperative and perioperative patient selection and management of patients in conjunction with HF physicians is imperative.…”

Present and Future Surgical Options for Tricuspid Regurgitation

“…In this line, Wang et al . [ 61 ] analyzed demographic characteristics, complications, and outcomes of 92, 86, and 84 TR patients who underwent TR surgical repair (STVr) or replacement (STVR), and transcatheter repair (TTVr), respectively, using real-world data from the National Inpatient Sample (NIS) database. The study found that TTVr patients were significantly older than STVr (65.03 years in STVr, 66.3 years in STVR, 71.09 years in TTVr, p 0.05).…”

“…Patients who received STVr or STVR presented a higher mortality rate (8.7% and 3.5%, respectively) compared to TTVr (1.2%), and were more likely to experience perioperative complications, including third-degree atrioventricular block, respiratory failure, respiratory complications, and acute kidney injury. Moreover, costs of care (USD$ 37,995 356,008.523 STVr vs. USD$ 198,397 188,943.082 TTVr, p 0.05; USD$ 470,948 614,177.568 STVR vs. USD$ 198,397 188,943.082 TTVr, p 0.05) and hospital lengths-of-stay (15.4 15.19 STVr vs. 9.6 10.21 days TTVr, p = 0.267; 24.7 28.81 STVR vs. 9.6 10.21 days TTVr, p 0.05) were higher for STVr or STVR than for TTVr [ 61 ].…”