JACC. Advances · 2026
Association of Predicted Surgical Risk With 3-Year Outcomes After Isolated Tricuspid Valve Surgery: An Analysis of Medicare Beneficiaries.
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Mehaffey J Hunter, Cohen David J, Davidson Charles, Hahn Rebecca, Daggubati Ramesh, Hayanga J W, Badhwar Vinay
Аннотация
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.
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.