Interventions for valvular disease and heart failure

Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies

EuroIntervention 2022;18:840-851. DOI: 10.4244/EIJ-D-22-00442

Andrea Scotti
Andrea Scotti1,2, MD; Matteo Sturla1, MD; Juan F. Granada1,2, MD; Susheel K. Kodali3, MD; Augustin Coisne1,2, MD, PhD; Antonio Mangieri4, MD; Cosmo Godino5, MD; Edwin Ho1, MD; Ythan Goldberg1, MD; Mei Chau1, MD; Ulrich P. Jorde1, MD; Mario J. Garcia1, MD; Francesco Maisano5, MD; Vinayak N. Bapat6, MD; Gorav Ailawadi7, MD, MBA; Azeem Latib1, MD
1. Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA; 2. Cardiovascular Research Foundation, New York, NY, USA; 3. Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA; 4. Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy; 5. Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy; 6. Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA; 7. Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA

Background: Transcatheter tricuspid valve replacement (TTVR) is rapidly emerging as a therapeutic option amongst patients with secondary tricuspid regurgitation. Historical data from surgical tricuspid valve replacement (TVR) studies may serve as a benchmark for the development of TTVR trials.

Aims: The aim of the study was to investigate the early and late outcomes following isolated surgical TVR.

Methods: Multiple electronic databases were searched to identify studies on isolated surgical TVR. The prespecified primary endpoint was operative mortality; secondary endpoints were early and late outcomes. Overall estimates of proportions and incidence rates with 95% confidence intervals (CI) were calculated using random-effects models. Multiple sensitivity analyses accounting for baseline characteristics, country and the operative period were applied.

Results: A total of 35 studies (5,316 patients) were included in this meta-analysis. The operative period ranged from 1974 to 2019. The overall rate of operative mortality was 12% (95% CI: 9-15), with higher mortality for patients who were operated on before 1995, who had prior cardiac surgeries, or who had liver disease. The most frequent clinical events were pacemaker implantation (10% [95% CI: 6-16]), bleeding (12% [95% CI: 8-17]), acute kidney injury (15% [95% CI: 9-24]) and respiratory complications (15% [95% CI: 12-20]). At follow-up analysis of the bioprosthetic TVR, there was an incidence rate per 100 person-years of 6 (95% CI: 2-13) for death and 8 (95% CI: 5-13) for recurrence of significant tricuspid regurgitation.

Conclusions: This meta-analysis provides an overview of the historical clinical outcomes following isolated surgical TVR. These findings can support the development of future clinical trials in the tricuspid space by providing thresholds for clinical outcomes.

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