MP13. Concomitant tricuspid valve ring annuloplasty during mitral valve surgery : A systematic review and meta-analysis of clinical studies
Presented During: Moderated E-Posters
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Dr Poon is a cardiothoracic trainee in the United Kingdom. He received specialty training in Cardiff, Swansea and most recently Papworth Hospital, Cambridge. He has subspecialty interest in structural heart diseases including mitral and aortic diseases.
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
Objective: Tricuspid valve regurgitation (TR) is common in patients with severe mitral valve disease and operative management of moderate TR is contentious. The decision as to whether to perform concomitant tricuspid valve ring annuloplasty for patients with moderate TR or less-than-moderate TR with a dilated TV annulus at the time of mitral valve surgery remains a contentious topic. A meta-analysis was performed to assess the clinical outcomes of concomitant tricuspid valve ring annuloplasty during mitral valve surgery.
Methods: A meta-analysis of comparative studies including mitral valve ( MV) surgery only versus MV surgery and concomitant TV ring annuloplasty (TVA). Primary outcome included in-hospital mortality, TR progression, and PPM implantation rate. Secondary outcome included re-operation for TR (at longest follow up available). Fixed-effect analysis was performed using pooled odd ratios (OR) via RevMan in accordance to Cochrane protocol and PRISMA guidelines.
Results: 8 studies met the eligibility criteria (2 RCTs, 6 cohort studies) with 1941 patients included in the final analysis (1090 patients in MV + TVA, 851 in MV only). The in-hospital mortality was comparable between the two groups ( 3.0% vs. 3.7%, OR=0.79, p=0.38). MV and concomitant TVA is associated with fewer moderate/severe TR progression (3.0% vs. 9.6% OR=0.29 ( 95% CI 0.15-0.55) p=0.0001). The rate of PPM implantation is higher in MV +TVA group although this did not reach statistical significance. (7.6% vs 5.3% OR=1.30 (95% CI 0.85-1.98) p=0.23). No significant difference in rate of re-operation between the two groups was detected.
Conclusions: Concomitant tricuspid valve ring annuloplasty during mitral valve surgery can be safely performed without increasing mortality and morbidity risks. There is a tendency for increased rate of PPM implantation in concomitant TVA although this did not reach statistical significance. Concomitant TVA is associated with a significantly lower incidence of post-operative moderate/severe TR progression. Further prospective and RCT studies are needed to evaluate the impact of concomitant TVA on right ventricular function and long term clinical benefits.
Methods: A meta-analysis of comparative studies including mitral valve ( MV) surgery only versus MV surgery and concomitant TV ring annuloplasty (TVA). Primary outcome included in-hospital mortality, TR progression, and PPM implantation rate. Secondary outcome included re-operation for TR (at longest follow up available). Fixed-effect analysis was performed using pooled odd ratios (OR) via RevMan in accordance to Cochrane protocol and PRISMA guidelines.
Results: 8 studies met the eligibility criteria (2 RCTs, 6 cohort studies) with 1941 patients included in the final analysis (1090 patients in MV + TVA, 851 in MV only). The in-hospital mortality was comparable between the two groups ( 3.0% vs. 3.7%, OR=0.79, p=0.38). MV and concomitant TVA is associated with fewer moderate/severe TR progression (3.0% vs. 9.6% OR=0.29 ( 95% CI 0.15-0.55) p=0.0001). The rate of PPM implantation is higher in MV +TVA group although this did not reach statistical significance. (7.6% vs 5.3% OR=1.30 (95% CI 0.85-1.98) p=0.23). No significant difference in rate of re-operation between the two groups was detected.
Conclusions: Concomitant tricuspid valve ring annuloplasty during mitral valve surgery can be safely performed without increasing mortality and morbidity risks. There is a tendency for increased rate of PPM implantation in concomitant TVA although this did not reach statistical significance. Concomitant TVA is associated with a significantly lower incidence of post-operative moderate/severe TR progression. Further prospective and RCT studies are needed to evaluate the impact of concomitant TVA on right ventricular function and long term clinical benefits.