Tricuspid valve repair: A systematic review and meta-analysis of different surgical techniques and their long-term results
Tulio Caldonazo, Leo Consoli, Hristo Kirov, Murat Mukharyamov, Sophie Tkebuchava, Felipe Passos, Torsten DoenstAbstract
Objectives
The degree of tricuspid regurgitation (TR) is related to mortality. The majority of TR is secondary, and surgery consists mainly of annuloplasty repair (TVr), but repair durability is a prerequisite for a lasting treatment effect. We performed a systematic assessment of TVr durability.
Methods
A systematic literature search was performed (MEDLINE, Cochrane Library and Web of Science). Follow-up of TVr techniques and TR recurrence rates were used to estimate incidence rates which were then meta-analyzed using a single-arm meta-analysis model with random-effects. Comparisons between techniques were performed to obtain incidence rate ratios (IRR) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05.
Results
A total of 50 studies met the criteria for inclusion (5 randomized and 45 observational), with 15,563 patients, representing 79,763 patient-years (mean follow-up: 3.9 years). Overall recurrence rate was 2.73 per 100 person-years (95% CI 2.15-3.47). Ring annuloplasty had lowest rates (1.81; 95% CI 1.17-2.79), followed by band (2.58; 95% CI 1.66-4.00) and suture (4.06; 95% CI 2.93-5.64). There was a large difference in treatment effects within and between groups (P for interaction=0.011). Compared to suture, ring annuloplasty was associated with lower TR recurrence (IRR 0.45; P = 0.003), but not versus band (IRR 0.71; P = 0.26). There was no difference between band and suture (IRR 0.63; P = 0.12).
Conclusions
Long-term durability of TVr techniques is extremely heterogeneous. We identified the use of rigid rings and flexible bands as being associated with lower recurrence rates compared to suture techniques.