Efficacy and Safety of Concomitant Tricuspid Repair in Patients Undergoing Mitral Valve Surgery: a Systematic Review and Meta-Analysis |
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| Institution: | 1. Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan;2. Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN;3. Leyhigh Valley Heart Institute, Leyhigh Valley Health Network, Allentown, PA, USA;1. Sumy State University, Toufik''s World Medical Association, Sumy, Sumy Oblast, Ukraine;2. Nishtar Medical University, Nishtar Rd, Gillani Colony, Multan, Punjab, Pakistan;3. Department of Clinical Sciences, Division of Health Sciences, University of Monterrey, San Pedro Garza Garc?a, Nuevo Leon, Mexico;4. Department of Internal Medicine, Ross University School of Medicine, Bridgetown, State of Barbados, Barbados;5. Federal University of Parana, Curitiba, Paraná, Brazil;6. Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, Florida;7. Ohio State University, Columbus, OH;8. Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, Florida;9. Universidad del Norte, Barranquilla, Atlántico, Colombia;10. Suleyman Demirel University, Isparta, Isparta Province, Turkey;11. Mayo Hospital Lahore, Punjab, Pakistan;12. Anglia Ruskin Medical School, East Rd, Cambridge, UK;13. Division of Cardiovascular Medicine, Texas Tech University Health Sciences Center El Paso, Texas;14. Department of Cardiology, Westchester Medical Center, Valhalla, New York;15. Department of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York;p. Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania;1. Division of Cardiology, Duke University School of Medicine, Durham, NC;2. Division of Preventive Cardiology, Houston Methodist Academic Institute, Houston, TX;3. Baylor Scott and White Research Institute, Dallas, TX;4. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA;1. Cardiorespiratory Emergencies, Hospital General de México “Dr Eduardo Liceaga”, 06720, Mexico City, Mexico;2. Pulmonary Circulation Clinic, Hospital General de México “Dr. Eduardo Liceaga”, 06720, Mexico City, Mexico;3. Faculty of Medicine, National Autonomous University of Mexico, Mexico City, Mexico;4. Pulmonology Department, Hospital General de México “Dr. Eduardo Liceaga”, 06720, Mexico City, Mexico;5. Directorate of Research, Hospital General de Mexico “Dr. Eduardo Liceaga,” 06720, Mexico City, Mexico;6. I.M. Sechenov First Moscow State Medical University (Sechenov University), Department of Radiology, 119992, Moscow, Russia;7. Radiology Service, Hospital General de México “Dr Eduardo Liceaga”, 06720, Mexico City, Mexico;1. General Surgery Resident, UT Health San Antonio, Texas, USA;2. Cleveland Clinic Abu Dhabi, UAE;3. Consultant Cardiothoracic Surgery, Cleveland Clinic Abu Dhabi, UAE;4. Consultant Cardiologist, Cleveland Clinic Ohio, USA;5. Rush University, Chicago, USA;1. Department of Medicine, Duke University Medical Center, Durham, NC, USA;2. Duke Clinical Research Institute, Durham, NC, USA;3. Department of Medicine, Ziauddin Medical University, Karachi, Pakistan;4. Department of Medicine, Division of Cardiology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA;5. Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, California, USA;6. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA;7. Department of Medicine, St Boniface Hospital University of Manitoba, Winnipeg, MB, Canada |
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| Abstract: | Tricuspid valve repair (TVR) is recommended for patients with moderate primary tricuspid regurgitation (TR), those with moderate TR, and a history of heart failure without annular dilation, while being essential for patients with severe secondary TR undergoing MVS. The meta-analysis aimed to evaluate the efficacy and safety of tricuspid valve repair in patients undergoing MVS. We systematically searched PubMed, Embase, and Google Scholar through January 2022, and studies comparing patients with TVR and those without TVR were selected. The primary outcomes were 30-day, and all-cause mortality. In this meta-analysis, 20 studies were included with a patient population of 72,422. No significant differences were observed between patients undergoing TVR with MVS, in comparison to MVS group only for the primary outcomes i.e., 30-day mortality (RR: 1.14, 95% CI 0.69, 1.87], and all-cause mortality (RR: 1.16, 95% CI 0.86, 1.57]. From the secondary outcomes, pacemaker insertion (RR: 2.62, 95% CI 2.24, 3.06]), new-onset TR or progression (RR: 0.32, 95% CI 0.16, 0.66]), stroke (RR: 1.22, 95% CI 1.05, 1.42]), cross-clamp time (WMD: 17.67, 95% CI 13.96, 21.37]), surgery time (WMD: 43.59, 95% CI 37.07, 50.10]), ICU time (WMD: 19.50, 95% CI 9.31, 29.67]), and ventilation time (WMD: 6.62, 95% CI 0.69, 12.55]) were significant. However, major bleeding events, atrial fibrillation, renal failure, heart failure hospitalization, postoperative MI, wound infection, early or prolonged morbidity, cardiopulmonary bypass time, and duration of hospital stay were non-significant. Our meta-analysis has furthered the discussion for weighing the risks and benefits of pursuing TVR during MVS. |
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