Beating Tricuspid Surgery is a Viable Option with Similar Outcomes to Traditional Surgery: a Propensity Score Analysis

ABSTRACT

Introduction:  The advantages of beating heart tricuspid surgery without aortic cross-clamping remain underexplored, particularly in the context of concomitant procedures. This study aimed to compare the shortand long-term outcomes of tricuspid valve surgery performed with and without aortic cross-clamping.

Methods:  This retrospective cohort study included 1,154 patients who underwent isolated or concomitant tricuspid valve surgery between 2009 and 2021. Patients were divided into two groups, those who underwent surgery without aortic cross-clamping (beating heart, n = 170) and those with cross-clamping (arrested heart, n = 984). Propensity score matching identified 139 matched pairs.

Results:  The mean age was 56 years (25^th-75^th percentiles: 47, 65), with 61.27% female patients and 95% undergoing concomitant procedures. In the unmatched cohort, patients who underwent beating heart surgery had higher preoperative creatinine clearance (93.53 vs. 81.33 ml/min, P = 0.036) and shorter intensive care unit stays (3 [1 - 5] vs. 3 [1 - 6] days, P = 0.037). However, after propensity score matching, there were no significant differences in postoperative heart block (P > 0.99), creatinine levels (P = 0.780), or tricuspid regurgitation grade (P = 0.082) between the two groups. Long-term outcomes, including 10-year freedom from reintervention (95% vs. 98%, log-rank P = 0.087), survival (77% vs. 82%, P = 0.964), and heart failure rehospitalization (76% vs. 77%, P = 0.444), were also comparable between the matched cohorts.

Conclusion:  Concomitant tricuspid surgery without aortic cross-clamping is a viable alternative to traditional arrested heart surgery, with no significant differences in shortor long-term outcomes.

Keywords:
Tricuspid Valve Insufficiency; Constriction; Cardiac Surgical Procedures; Heart Failure; Cardiac Arrhythmias; Intensive Care Units; Patient Readmission.