Tricuspid valve repair concomitant with mitral valve surgery: a systematic review and meta-analysis

Abstract

Background: Uncertainties persist about whether to aggressively and effectively treat tricuspid regurgitation (TR) during mitral valve (MV) surgery.

Review methods: Systematic literature searches were performed in five databases to collect all relevant studies published before May 2022 on whether the tricuspid valve was treated during MV surgery. Separate meta-analyses were performed on data from unmatched studies and randomized controlled trials (RCT)/adjusted studies.

Main results: A total of 44 publications were included, of which eight were RCT studies and the rest were retrospective studies. There was no difference in 30-day mortality [odds ratio (OR): 1.00, 95% CI: 0.71-1.42, OR: 0.66, 95% CI: 0.30-1.41)] or overall survival [hazard ratio (HR): 1.01, 95% CI: 0.85-1.19, HR: 0.77, 95% CI: 0.52-1.14] in unmatched studies and RCT/adjusted studies. Late mortality (OR: 0.37, 95% CI: 0.21-0.64) and cardiac-related mortality (OR: 0.36, 95% CI: 0.21-0.62) were lower in the tricuspid valve repair (TVR) group in the RCT/adjusted studies. In the unmatched studies, overall cardiac mortality (OR: 0.48, 95% CI: 0.26-0.88) was lower in the TVR group. In the late TR progression analysis, the late TR progression was lower among patients in the concomitantly intervened tricuspid group, and patients in the untreated tricuspid group were prone to TR progression in both studies (HR: 0.30, 95% CI: 0.22-0.41, HR: 0.37, 95% CI: 0.23-0.58).

Conclusions: TVR concomitant with MV surgery is most effective in patients with significant TR and dilated tricuspid annulus, especially those with a significantly reduced risk of distant TR progression.