Jae Woong Choi1, Myoung-Jin Jang2, Kyung Hwan Kim1, Ho Young Hwang1. 1. Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea. 2. Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage in preserving right ventricular function and disadvantages such as a higher risk of repair failure in the long-term compared with tricuspid valve replacement (TVR). This study was conducted to compare the results of TVr with those of TVR to find an optimal treatment option. METHODS: A literature search of 5 databases was performed. The primary outcome was all-cause mortality. Secondary outcomes were tricuspid reoperation and valve-related events. Subgroup analyses were performed according to the risk of bias, year of publication and proportions of patients with tricuspid regurgitation Grade ≥3, functional aetiology and isolated tricuspid valve surgery. Publication bias was explored using the funnel plot and Egger's test. RESULTS: Seventeen retrospective studies involving 4561 patients (TVr group = 3432 patients and TVR group = 1129 patients) were included. A pooled analysis showed that the risk of all-cause mortality was significantly higher in the TVR group than in the TVr group [hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no significant differences in tricuspid valve reoperation in 6 studies and valve-related events in 5 studies between the TVR and TVr groups [hazard ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91-2.38), respectively]. None of the subgroup analyses demonstrated a significant difference in the hazard ratio of all-cause mortality. No publication bias was identified for the primary and secondary outcomes. CONCLUSIONS: This meta-analysis indicates that TVr is more beneficial compared with TVR in terms of all-cause mortality. From the available data, TVr is not associated with an increased risk of tricuspid reoperation compared with TVR.
OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage in preserving right ventricular function and disadvantages such as a higher risk of repair failure in the long-term compared with tricuspid valve replacement (TVR). This study was conducted to compare the results of TVr with those of TVR to find an optimal treatment option. METHODS: A literature search of 5 databases was performed. The primary outcome was all-cause mortality. Secondary outcomes were tricuspid reoperation and valve-related events. Subgroup analyses were performed according to the risk of bias, year of publication and proportions of patients with tricuspid regurgitation Grade ≥3, functional aetiology and isolated tricuspid valve surgery. Publication bias was explored using the funnel plot and Egger's test. RESULTS: Seventeen retrospective studies involving 4561 patients (TVr group = 3432 patients and TVR group = 1129 patients) were included. A pooled analysis showed that the risk of all-cause mortality was significantly higher in the TVR group than in the TVr group [hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no significant differences in tricuspid valve reoperation in 6 studies and valve-related events in 5 studies between the TVR and TVr groups [hazard ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91-2.38), respectively]. None of the subgroup analyses demonstrated a significant difference in the hazard ratio of all-cause mortality. No publication bias was identified for the primary and secondary outcomes. CONCLUSIONS: This meta-analysis indicates that TVr is more beneficial compared with TVR in terms of all-cause mortality. From the available data, TVr is not associated with an increased risk of tricuspid reoperation compared with TVR.
Authors: Tom Kai Ming Wang; Brian P Griffin; Rhonda Miyasaka; Bo Xu; Zoran B Popovic; Gosta B Pettersson; Alan Marc Gillinov; Milind Y Desai Journal: Open Heart Date: 2020-03-17