BACKGROUND: Once termed the “forgotten valve,” tricuspid regurgitation (TR) is now recognized as a significant contributor to morbidity and mortality. While isolated tricuspid surgery historically carried high perioperative risk and limited indications, the advent of transcatheter edge-to-edge repair (TEER) and other percutaneous therapies has transformed the treatment landscape.
OBJECTIVE: This study aimed to analyze national trends in the surgical management of tricuspid valve disease in Germany from 2011 to 2023.
METHODS: Using the German DRG database, all inpatient cases with tricuspid valve surgery were identified via OPS codes. Comorbidities and perioperative outcomes were captured using ICD-10-GM and OPS codes.
Results: Between 2011 and 2023, a total of 47,279 patients (21,777 female, 25,502 male) underwent tricuspid valve surgery. The mean age was 66.3 years (median 71). The annual number of surgeries declined slightly but not significantly (p=0.10). Most patients (39,276) received annuloplasty, while 3,749 underwent valve replacement and 5,660 reconstruction. Concomitant left sided heart valve surgery was performed in 77.1% of cases (N=36,434), whereas coronary bypass surgery was less frequent (20.4%, N=9,663). Overall, in-hospital mortality was 12.38%. Rates of mortality and MACCE decreased significantly over the study period. Mortality was slightly but significantly higher in patients undergoing isolated TV surgery (11%) than is those with concomitant left sided heart valve surgery. Notably, it increased substantially to 20% in those who underwent a combination of more than two procedures (TV surgery, left sided heart valve surgery, CABG, and rhythm procedures).
Conclusion: Tricuspid valve surgery in Germany has remained relatively stable in volume despite the expansion of percutaneous treatment options. Although perioperative outcomes have improved, mortality remains high, underscoring the need for ongoing research.
