599 Case-Volumes and Outcomes Following Concomitant Aortic, Mitral and Tricuspid Valves Surgery Statewide Over 17-Years: A Population-Linkage Study

Abstract

Studies reporting concomitant cardiac tri-valvular surgery remains rare. Prevalence and outcomes of these patients have not been reported in Australia. From the Admitted-Patient-Data-Collection registry, all New South Wales residents who underwent surgery for aortic, mitral and tricuspid valves pathology between 1-July, 2001 and 31-December, 2018 were identified. Cause-specific mortality were tracked from the statewide death registry. Concomitant tri-valvular surgery comprised 1.2% (347/28667 cases) of all cardiac valves surgeries statewide. Case-volumes rose from 8 in year-2002 to a peak of 37 cases in 2012, and between 23 and 30 cases-per-annum since. The study cohort comprised 340 persons (mean[±SD] age: 68.2±15.2yrs; 50% males); 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 valve was replacement (95.9% and 70.6% respectively). Mitral valve replacement was more common in females than males (79.4% vs 61.8%, p=0.001). Overall mitral valve repair rate was 10% (males vs females: 13.5% vs 6.5%, p=0.045). For tricuspid valve, annuloplasty was performed in 90.6% of patients. Cardiac-related (28.0%), heart failure (24.0%) and sepsis (24.0%) were the three main in-hospital cause-specific deaths, with no stroke-related death. Post-discharge, the main cardiovascular cause-specific death was heart failure (22.5%), and 6.7% and 4.2% were from embolic and haemorrhaging stroke respectively. Sepsis (20.0%) was the main noncardiovascular cause-specific death post-discharge. Concomitant cardiac tri-valvular surgery remains rare and associated with high short and intermediate-term mortality. Careful patient selection and better postoperative care is required to improve outcomes of these patients.