Repair versus replacement: a meta-analysis on the efficacy of isolated tricuspid valve surgery / 中华胸心血管外科杂志

ABSTRACT

Objective:We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.Methods:We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, VIP database and WanFang database from the inception to September 30, 2021 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:A total of 18 articles were included, covering 10 023 patients, totalling 4 749 repairs and 5 274 replacements. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs. 9.9%, OR=0.64(0.44, 0.93). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs. 15.6%, OR=0.81(0.72, 0.92) and pacemaker implantation 7.9% vs. 26.4%, OR=0.24 (0.21, 0.30). There were no differences in rates of hospital stroke 14.4% vs. 10.3% , OR = 1.41 (0.98, 2.04) and late mortality rates 13.9% vs. 16.1%, OR=0.91(0.49, 1.69). Conclusion:Isolated tricuspid valve repair is 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.