Isolated tricuspid valve surgery: outcomes stratified by risk profile single center experience

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Abstract Background The tricuspid valve disease has recently gained awareness due to its significant morbidity and mortality if left untreated. This study examines isolated tricuspid valve surgery’s clinical characteristics, risk factors, and association with short and long-term outcomes. Methods This retrospective cohort study analyzed 42 patients undergoing isolated tricuspid valve surgery from 2018 to 2024 at a single tertiary center. Patients were grouped based on primary or secondary tricuspid regurgitation (TR). Baseline clinical characteristics, surgical details, and outcomes were assessed, with further stratification by Triscore risk. Results The study included 42 patients, with a mean age of 60±16 years, and 62% female. Primary TR was present in 48% (n=20), and secondary TR in 45% (n=19). A history of prior cardiac surgery was noted in 26%. Secondary TR patients were not significantly older (70±9 vs. 50±15 years, p=0.07) and were predominantly female (84% vs. 40%, p=0.005). They also presented with worse functional status (NYHA >2 in 74% vs. 40%, p=0.01), higher NTproBNP levels (2131 vs. 627, p=0.01), and elevated Triscore risk (>3 in 79% vs. 45%, p=0.05). There were no other differences in comorbidities prevalence between groups (table 1). Surgery consisted of tricuspid valve repair in 56% and replacement in 44%, with bioprostheses used in 88% of replacements. Prosthesis size averaged 31±2 mm, while annulus size for repairs was 33±2 mm, with no differences between groups. Intraoperative mortality was 0%, and complications occurred in 14% (table 2). During hospitalization, 26% of patients experienced complications, but the 30-day mortality rate was 0%. Patients with primary TR had non-significant more complications (42% vs. 16%, p=0.7) and a non-significant higher rate of complete AV block (15% vs. 0%, p=0.08). One-year mortality and readmission rates were 7% (table 3). Triscore stratification revealed a clear association with outcomes. Patients with a Triscore >7 had a one-year mortality and hospitalization rate of 60%, compared to 11% for scores between 3-6 and 0% for scores <3 (p<0.001). Conclusions This study highlights the increasing focus on tricuspid valve disease and the utility of the Triscore for risk stratification. Low-risk patients (Triscore <3) had excellent outcomes, with no mortality or hospitalizations in one year, demonstrating the safety and efficacy of isolated tricuspid valve surgery. On the other hand, high-risk patients (Triscore>7) had significantly worse outcomes, emphasizing the importance of careful patient selection and management. Early intervention and tailored strategies are critical to improving survival and reducing complications in this patient population.Baseline, surgery and outcomes Survival Curves

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