Rigid ring vs. flexible band for tricuspid valve repair in patients with tricuspid valve regurgitation: A systematic review and meta-analysis

Rigid ring and Flexible band are techniques used to repair tricuspid valve regurgitation. The comparison between both techniques' effectiveness is controversial in the literature. We conducted this systematic review and meta-analysis to compare the safety and efficacy of rigid ring versus flexible band for tricuspid valve repair in patients with tricuspid valve regurgitation. We conducted a PRISMA-compliant systematic review and meta-analysis. A systematic search was performed in major databases, including PubMed, Scopus, Web of Science, and Cochrane CENTRAL to identify relevant published studies. Data were extracted and analyzed using Stata (version 17 for Mac) and Revman (version 5.4 for Windows). Twelve studies were included in this meta-analysis. Total number of patients was 4259. The rigid ring wasn't superior to the flexible band in terms of postoperative tricuspid regurgitation RR 0.74, 95 % CI (0.43–1.27) (P = 0.29). However, the results were not homogeneous. After employing sensitivity analysis, the significance of the pooled effect estimate didn't change, showing no significant difference between the two annuloplasty RR 0.72, 95%CI (0.45–1.15). On the other hand, the rigid ring was associated with a higher bypass time than the flexible band (RR 4.85, P = 0.00). There were no differences between the two groups in terms of hospital stay, ICU stays, prolonged ventilation, mechanical ventilation time, annuloplasty size, stroke, concomitant mitral valve surgery, concomitant aortic valve surgery, atrial fibrillation, pacemaker implantation, low cardiac output, in-hospital death, or late death (all P > 0.05). Our study findings suggested no difference between rigid ring compared to flexible band regarding the rates of postoperative tricuspid regurgitation; however, rigid ring may encompass a higher bypass time. Therefore, further research is required to ensure our findings. What is already known about this subject? • Tricuspid regurgitation (TR) is a prevalent valvular heart condition with various underlying causes. • Tricuspid valve annuloplasty (TVA) is a preferred surgical approach for TR, and it involves the use of both rigid rings and flexible bands. • The debate regarding the superiority of rigid rings versus flexible bands for TVA remains ongoing in the literature. What does this study add? • The study found no significant difference in postoperative tricuspid regurgitation rates between the two techniques. • However, it revealed that rigid ring annuloplasty was associated with a longer bypass time compared to flexible band annuloplasty. How might this impact on clinical practice? • Clinicians can consider both rigid rings and flexible bands as effective options for tricuspid valve repair, as they offer similar postoperative outcomes. • Surgeons should be aware that using a rigid ring may slightly prolong the bypass time, which could influence surgical planning.