Introduction
Studies have reported increasing triple valve surgery (TVS, defined as concomitant
aortic, mitral and tricuspid valves surgery) incidence and improved postoperative
survival. The epidemiology and outcome of TVS is not known in Australia.
Methods
From the Admission-Patient-Data-Collection registry, all New South Wales residents
who underwent cardiac valve surgery between 1 July 2001 and 31 December 2018 were
identified, with cause-specific mortality tracked from the death registry.
Results
Triple valve surgery comprised 1.2% (347/28,667 cases) of all valvular surgeries.
Volumes rose from eight cases-per-annum in 2002 to a peak of 37 in 2012, and between
23 and 30 cases-per-annum since. Mean (±SD) age of study cohort (n=340 persons) was
68.2±15.2 years (50% male); 20.3% had concomitant coronary-artery-bypass-surgery (males
vs females: 29.4% vs 11.2%, p<0.001). Main surgery on aortic and mitral valves was
replacement (95.9% and 70.6% respectively). Tricuspid valve annuloplasty was performed
in 90.6% of patients. Cumulative in-hospital, 180-day, and total mortality (mean follow-up=4.9±4.0
yrs) was 7.4%, 11.8% and 42.6%, respectively. Heart failure (24.0% in-hospital, 22.5%
post-discharge) and sepsis (24.0% in-hospital, 20.0% post-discharge) were the main
cause-specific deaths. There was no in-hospital stroke-related death. Age (median
>72 yrs; hazard ratio [HR]=1.95, 95%CI=1.37–2.79), malignancy (HR=6.35, 95%CI=2.21–18.26),
heart failure (HR=1.79, 95%CI=1.25–2.57) and chronic kidney disease (CKD) (HR=2.21,
95%CI=1.39–3.51) (all p<0.005) were independent predictors during intermediate-term
follow-up.
Conclusions
Triple valve surgery remains rare in Australia and is associated with high mortality.
Multi-centred collaboration and access to comprehensive clinical data are required
to identify the drivers of poor outcome.
Keywords
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Article info
Publication history
Published online: November 05, 2022
Accepted:
September 30,
2022
Received in revised form:
September 9,
2022
Received:
October 20,
2021
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
