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Original research
Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients
  1. Tom Kai Ming Wang1,
  2. Brian P Griffin1,
  3. Rhonda Miyasaka1,
  4. Bo Xu1,
  5. Zoran B Popovic1,
  6. Gosta B Pettersson2,
  7. Alan Marc Gillinov2 and
  8. Milind Y Desai1
  1. 1Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
  2. 2Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, United States
  1. Correspondence to Dr Milind Y Desai; desaim2{at}ccf.org

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.

  • cardiac surgery
  • tricuspid valve disease
  • surgery-valve
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors TKMW and MYD were involved with planning, literature search, article screening, data extraction, statistical analysis, data interpretation, writing and final approval of the manuscript. BG, RM, BX, ZBP, GP and AMG were involved in the planning, data interpretation, revision and final approval of the manuscript.

  • Funding TKMW is supported by the Overseas Clinical and Research Fellowship (grant number 1775) from the National Heart Foundation of New Zealand. MYD is supported by the Haslam Family endowed chair in cardiovascular medicine at Cleveland Clinic.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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