MP77. Tricuspid Valve Repair: A Systematic Review and Meta-Analysis of Different Surgical Techniques and Their Long-Term Results
Presented During: Moderated E-Posters
Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Germany
Jena, Thuringia
Germany - Contact Me
Cardiothoracic Surgery - Thuringia Heart Center, Jena University Hospital, Germany
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: It is generally accepted, that the degree of tricuspid valve regurgitation (TR) is related to mortality. The majority of TR is secondary (80%), and surgery consists mainly of annuloplasty repair (TVR). The impact of TVR on mortality is uncertain. Since durability of TVR should be a prerequisite for a lasting treatment effect, we systematically assessed the durability of tricuspid annuloplasty.
Methods: A systematic literature search was performed (MEDLINE, Cochrane Library and Web of Science) assessing long-term results of suture, ring and band TVR annuloplasty techniques. From the qualifying studies, follow-up of respective TVR technique and TR recurrence rate were illustrated in the bubble plot (Figure A). Furthermore, an overall distribution plot was made based on the failure rate of each study weighted by joining the variables population size and follow-up (Figure B), p-value was calculated based on the Kruskal-Wallis-Test.
Results: A total of 3,676 studies were retrieved from the systematic search, of which 43 met the criteria for inclusion in the final analysis. Five studies were randomized clinical trials and 38 were observational cohort studies (13 present adjusted populations). A total of 13,870 patients from 19 different nations were included. The follow-up ranged from 1 to 18 years (mean±SD: 3.9±3.8 years). Mean TR recurrence rate was 14% (Figure B: red line). There was a large heterogeneity of treatment effect with the different types of annuloplasty and the return of TR over time is high. The figure shows that ring annuloplasty was associated with the lowest re-TR rate and suture annuloplasty with the highest. For suture annuloplasty, early re-TR rates have been demonstrated (within the first three years; Figure A). In the combined patient-follow-up analysis, ring annuloplasty had lowest re-TR rates (6.5%), followed by band (16%) and suture annuloplasty (19%).
Conclusions: Long-term durability of tricuspid valve annuloplasty techniques is suboptimal and heterogeneous. Based on these outcomes, it may still be reasonable to expect that a durable elimination of tricuspid regurgitation can deliver a survival advantage to these patients.
Methods: A systematic literature search was performed (MEDLINE, Cochrane Library and Web of Science) assessing long-term results of suture, ring and band TVR annuloplasty techniques. From the qualifying studies, follow-up of respective TVR technique and TR recurrence rate were illustrated in the bubble plot (Figure A). Furthermore, an overall distribution plot was made based on the failure rate of each study weighted by joining the variables population size and follow-up (Figure B), p-value was calculated based on the Kruskal-Wallis-Test.
Results: A total of 3,676 studies were retrieved from the systematic search, of which 43 met the criteria for inclusion in the final analysis. Five studies were randomized clinical trials and 38 were observational cohort studies (13 present adjusted populations). A total of 13,870 patients from 19 different nations were included. The follow-up ranged from 1 to 18 years (mean±SD: 3.9±3.8 years). Mean TR recurrence rate was 14% (Figure B: red line). There was a large heterogeneity of treatment effect with the different types of annuloplasty and the return of TR over time is high. The figure shows that ring annuloplasty was associated with the lowest re-TR rate and suture annuloplasty with the highest. For suture annuloplasty, early re-TR rates have been demonstrated (within the first three years; Figure A). In the combined patient-follow-up analysis, ring annuloplasty had lowest re-TR rates (6.5%), followed by band (16%) and suture annuloplasty (19%).
Conclusions: Long-term durability of tricuspid valve annuloplasty techniques is suboptimal and heterogeneous. Based on these outcomes, it may still be reasonable to expect that a durable elimination of tricuspid regurgitation can deliver a survival advantage to these patients.