Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients
ObjectivesTricuspid 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 approac...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2020-06-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/7/1/e001227.full |
| _version_ | 1819175515254161408 |
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| author | Brian P Griffin Rhonda Miyasaka Zoran B Popovic Gosta B Pettersson Alan Marc Gillinov |
| author_facet | Brian P Griffin Rhonda Miyasaka Zoran B Popovic Gosta B Pettersson Alan Marc Gillinov |
| author_sort | Brian P Griffin |
| collection | DOAJ |
| description | ObjectivesTricuspid 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.MethodsWe 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.ResultsThere 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.ConclusionIsolated 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. |
| first_indexed | 2024-12-22T20:56:05Z |
| format | Article |
| id | doaj.art-6eb187c3325e47e9af222b986c66eca1 |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-12-22T20:56:05Z |
| publishDate | 2020-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-6eb187c3325e47e9af222b986c66eca12022-12-21T18:12:57ZengBMJ Publishing GroupOpen Heart2053-36242020-06-017110.1136/openhrt-2019-001227Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patientsBrian P Griffin0Rhonda Miyasaka1Zoran B Popovic2Gosta B Pettersson3Alan Marc Gillinov4Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USASection of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USASection of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USADepartment of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, United StatesDepartment of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, United StatesObjectivesTricuspid 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.MethodsWe 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.ResultsThere 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.ConclusionIsolated 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.https://openheart.bmj.com/content/7/1/e001227.full |
| spellingShingle | Brian P Griffin Rhonda Miyasaka Zoran B Popovic Gosta B Pettersson Alan Marc Gillinov Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients Open Heart |
| title | Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients |
| title_full | Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients |
| title_fullStr | Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients |
| title_full_unstemmed | Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients |
| title_short | Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients |
| title_sort | isolated surgical tricuspid repair versus replacement meta analysis of 15 069 patients |
| url | https://openheart.bmj.com/content/7/1/e001227.full |
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