OBJECTIVES: In-hospital surgical and transcatheter management of tricuspid valve disease (TVD) and related burden on the Spanish Healthcare System has not been comprehensively addressed to date. This study evaluates intervention rates, health outcomes, and direct costs associated with TVD.

METHODS: All TVD interventions registered from January 2016 to December 2019 in the Spanish Ministry of Health’s public database (RAE-CMBD) using ICD-10 codification were included. Standardized rates (x10⁶) by year and region, the risk profile of patients (age-adjusted Charlson index), outcomes, length of stay (LoS), and DRG-based costs (€, 2019) were calculated. Factors associated with in-hospital death and LoS were analysed using multivariable regression analyses (logistic and negative binomial, respectively) combining statistical (Akaike’s criterion) and clinical knowledge for model optimization.

RESULTS: Isolated TVD was conducted in 813 cases with a national rate of 18.75 for the entire period, a death rate of 1.34, and in-hospital mortality of 7.13%. The unadjusted LoS for patients who have survived was 17.8 (17.4) days, of which 2.9 (7.7) were in the Intensive Care Unit (ICU). For those who died, the unadjusted LoS was 31.3 (27.2) days and 10.3 (17.6) in the ICU. Core variables related to death and LoS (p<0.05) were age and comorbidities (i.e., Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), Cancer); and year, non-elective entry, and comorbidities (i.e., CHF, Peripheral Vascular Disease, COPD, Renal disease, Moderate or severe liver disease), respectively. Per patient mean costs increased from 25,212€ (13,157€) in 2016 to 28,362€ (12,573€) in 2019. The annual mean cost was 5,355,333€, 1.58% of the total annual mean cost of procedures for structural heart disease.

CONCLUSIONS: Although the tricuspid has been historically considered the “forgotten” valve, TVD implies an increasing number of high-risk interventions involving considerable health resource utilization and economic burden.