20 Years of Triple-Valve Surgery in the United Kingdom: Demographic and Outcome Trends.

ABSTRACT

OBJECTIVES: To describe evolving demographic trends and early outcomes in patients undergoing triple-valve surgery in the UK, between 2000-2019. METHODS: We planned a retrospective analysis of national registry data including patients undergoing triple valve surgery for all aetiologies of disease. We excluded patients in a critical preoperative state and those with missing admission dates. The study cohort was split into 5 consecutive 4-year cohorts (groups A, B, C, D and E). The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission, re-exploration for bleeding, postoperative stroke and postoperative dialysis. Binary logistic regression models were used to establish independent predictors of mortality, stroke, postoperative dialysis and re-exploration for bleeding in this high-risk cohort. RESULTS: We identified 1,750 patients undergoing triple-valve surgery in the UK between 2000-2019. Triple valve surgery represents 3.1% of all patients in the dataset. Overall mean age of patients was 68.5 years ±12, having increased from 63 years ±12 in group A to 69 years ±12 in group E (p < 0.001). Overall in-hospital mortality rate was 9%, dropping from 21% in group A to 7% in group E (p < 0.001). Overall rates of re-exploration for bleeding (11%, p = 0.308) and postoperative dialysis (11%, p = 0.066) remained high across the observed time period. Triple valve replacement, redo sternotomy and poor preoperative left ventricular ejection fraction emerged as strong independent predictors of mortality. CONCLUSIONS: Triple valve surgery remains rare in the UK. Early postoperative outcomes for triple valve surgery have improved over time. Redo sternotomy is a significant predictor of mortality. Attempts should be made to repair the mitral and/or tricuspid valves where technically possible.