To identify determinants of in-hospital and mid-term outcomes after isolated tricuspid valve surgery (ITVS) as little is known regarding the impact of tricuspid regurgitation (TR) mechanism and clinical presentation.

Among 5661 consecutive adult patients who underwent a tricuspid valve surgery at 12 French tertiary centers in 2007-2017 collected from a mandatory administrative database, we identified 466 patients (8% of all tricuspid surgeries) who underwent an ITVS. Most patients presented with advanced disease (47% in NYHA III/IV, 57% with right-sided heart failure (HF) signs). TR was functional in 49% (22% with prior left-sided heart valve surgery and 27% isolated) and organic in 51% (infective endocarditis in 31% and other causes in 20%). In-hospital mortality and major complications rates were 10% and 31% respectively. Rates of survival and survival free of HF readmission were 75% and 62% at 5 years. Patients with functional TR incurred a worse in-hospital mortality than those with organic TR (14.4% vs. 6.3%, P=0.004) but presentation was more severe. Independent determinants of outcomes were NYHA class III/IV (OR=2.7[1.2–6.1], P=0.01), moderate/severe right ventricular dysfunction (OR=2.6[1.2–5.8], P=0.02), lower prothrombin time (OR=0.98[0.96–0.99], P=0.008) and with borderline statistical significance, right-sided HF signs (OR=2.4[0.9–6.5], P=0.06) while TR mechanism was not (OR=0.7[0.3–1.8], P=0.88).

ITVS was associated with high mortality and morbidity, both in-hospital and during follow-up, predicted by the severity of the presentation but not by TR mechanism. Our results suggest that TV intervention should be performed earlier in the course of the disease.