Contemporary practice patterns and outcomes of isolated tricuspid valve surgery in North America: systematic review with meta-analysis

Background: Management of isolated tricuspid valve surgery has evolved over recent decades with respect to operative timing, surgical strategy, and perioperative care. However, a contemporary synthesis of North American outcomes and practice patterns is lacking.
Methods: We performed a systematic review and meta-analysis of studies published between January 1, 2020, and August 30, 2025, reporting outcomes of isolated tricuspid valve surgery in North America. Outcomes assessed included operative mortality, temporal volume trends, repair vs. replacement outcomes, beating-heart techniques, and results from high-volume centers. Institutional outcomes were also reviewed.
Results: Twelve studies met the inclusion criteria. Operative mortality ranged from 5% to 8% in national cohorts and was approximately 2% at reference centers, with a declining trend over time. Mortality was lower among endocarditis patients as well as patients with better functional status and normal right ventricular function. Procedure volumes peaked around 2017 and have since plateaued or modestly declined, coinciding with increased use of transcatheter therapies. At our institution, 107 patients underwent isolated tricuspid valve surgery since 2014; 46% were reoperations, 54% were performed on a beating heart, 34% underwent repair, and in-hospital mortality was 1.9%. In the pooled meta-analysis of contemporary North American studies, operative mortality following isolated tricuspid valve surgery was 6.4% [95% confidence interval (CI): 4.9–8.3%], with significantly lower mortality observed with tricuspid valve repair (TVr) compared with tricuspid valve replacement (TVR) [odds ratio (OR) =0.74; 95% CI: 0.58–0.95]. In addition, pooled meta-analysis showed that TVr was associated with a significantly reduced risk of new permanent pacemaker (PPM) implantation (OR =0.39; 95% CI: 0.32–0.47).
Conclusions: Isolated tricuspid valve surgery is increasingly safe, especially among high-volume centers and carefully selected patients. Annual case volumes seem to have plateaued, likely due to the growing application of transcatheter therapies.