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Meta-Analysis
. 2020 Mar 17;7(1):e001227.
doi: 10.1136/openhrt-2019-001227. eCollection 2020.

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

Tom Kai Ming Wang  1 , Brian P Griffin  1 , Rhonda Miyasaka  1 , Bo Xu  1 , Zoran B Popovic  1 , Gosta B Pettersson  2 , Alan Marc Gillinov  2 , Milind Y Desai  1
Affiliations
Meta-Analysis

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

Tom Kai Ming Wang et al. Open Heart. .

Abstract

Objectives: Tricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical approach in isolated tricuspid valve disease. We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.

Methods: We searched Pubmed, Embase, Scopus and Cochrane from January 1980 to June 2019 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software.

Results: There were 811 article abstracts screened, from which 52 full-text articles reviewed and 16 studies included, totalling 6808 repairs and 8261 replacements. Mean age ranged from 36 to 68 years and females made up 24%-92% of these studies. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs 21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63 (1.10 to 2.41). There were no differences in rates of prolonged ventilation, mediastinitis, return to operating room or late mortality.

Conclusion: Isolated tricuspid valve repair was associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease, although its higher stroke rate warrants further research.

Keywords: cardiac surgery; surgery-valve; tricuspid valve disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Literature search disposition.
Figure 2
Figure 2
Forrest plots of pooled (A) operative mortality and (B) late mortality for tricuspid valve repair vs replacement.
Figure 3
Figure 3
Forrest plots of key pooled in-hospital morbidity outcomes (A) stroke, (B) renal failure and (C) pacemaker implantation following tricuspid valve repair vs replacement.
Figure 4
Figure 4
Funnel plot of operative mortality meta-analysis to assess publication bias.
See this image and copyright information in PMC

References

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