Key result
Concomitant tricuspid valve repair during mitral valve surgery significantly reduced late mortality (OR 0.37) and cardiac-related mortality compared to mitral valve surgery alone in RCT and adjusted studies.
Why the study?
Uncertainties persist regarding whether to aggressively and effectively treat tricuspid regurgitation during mitral valve surgery.
Does tricuspid valve repair concomitant with mitral valve surgery improve survival and prevent TR progression in patients with tricuspid regurgitation?
Meta-Analysis (n=12,661)
Does tricuspid valve repair concomitant with mitral valve surgery improve survival and prevent TR progression in patients with tricuspid regurgitation?
Odds Ratio: 0.37 (95% CI 0.21–0.64)
p-value: p=<0.01
Concomitant tricuspid valve repair during mitral valve surgery reduces late mortality, cardiac-related mortality, and TR progression, despite no difference in 30-day mortality or overall survival.
Supports consideration of concomitant tricuspid repair in mitral surgery; leaves open confirmation by dedicated RCTs.
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.
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Kang et al. (2023) conducted a meta-analysis in Mitral valve disease with tricuspid regurgitation (n=12,661). Tricuspid valve repair vs. No tricuspid valve repair (mitral valve surgery alone) was evaluated on Late mortality (RCT/adjusted studies) (OR 0.37, 95% CI 0.21-0.64, p=<0.01). Concomitant tricuspid valve repair during mitral valve surgery significantly reduced late mortality (OR 0.37) and cardiac-related mortality compared to mitral valve surgery alone in RCT and adjusted studies.
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