# Beating Tricuspid Surgery is a Viable Option with Similar Outcomes to Traditional Surgery: a Propensity Score Analysis

## TL;DR

This study shows that tricuspid surgery without aortic cross-clamping has similar outcomes to traditional surgery, even when done with other procedures.

## Contribution

The study demonstrates the viability of beating heart tricuspid surgery for concomitant procedures using propensity score matching.

## Key findings

- Beating heart surgery had shorter ICU stays and better preoperative kidney function in unmatched data.
- After matching, no significant differences were found in heart block, kidney function, or tricuspid regurgitation.
- Long-term outcomes like survival and rehospitalization were comparable between the two surgical approaches.

## Abstract

The advantages of beating heart tricuspid surgery without aortic
cross-clamping remain underexplored, particularly in the context of
concomitant procedures. This study aimed to compare the shortand long-term
outcomes of tricuspid valve surgery performed with and without aortic
cross-clamping.

This retrospective cohort study included 1,154 patients who underwent
isolated or concomitant tricuspid valve surgery between 2009 and 2021.
Patients were divided into two groups, those who underwent surgery without
aortic cross-clamping (beating heart, n = 170) and those with cross-clamping
(arrested heart, n = 984). Propensity score matching identified 139 matched
pairs.

The mean age was 56 years (25th-75th percentiles: 47,
65), with 61.27% female patients and 95% undergoing concomitant procedures.
In the unmatched cohort, patients who underwent beating heart surgery had
higher preoperative creatinine clearance (93.53 vs. 81.33 ml/min, P = 0.036)
and shorter intensive care unit stays (3 [1 - 5] vs. 3 [1 - 6] days, P =
0.037). However, after propensity score matching, there were no significant
differences in postoperative heart block (P > 0.99), creatinine levels (P
= 0.780), or tricuspid regurgitation grade (P = 0.082) between the two
groups. Long-term outcomes, including 10-year freedom from reintervention
(95% vs. 98%, log-rank P = 0.087), survival (77% vs. 82%, P = 0.964), and
heart failure rehospitalization (76% vs. 77%, P = 0.444), were also
comparable between the matched cohorts.

Concomitant tricuspid surgery without aortic cross-clamping is a viable
alternative to traditional arrested heart surgery, with no significant
differences in shortor long-term outcomes.