Repair versus replacement for the surgical correction of tricuspid regurgitation: a meta-analysis

OBJECTIVES: Tricuspid valve repair (TVr) has both a theoretical advantage in preserving right ventricular function and disadvantages such as a higher risk of repair failure in the long-term compared with tricuspid valve replacement (TVR). This study was conducted to compare the results of TVr with those of TVR to find an optimal treatment option. METHODS: A literature search of 5 databases was performed. The primary outcome was all-cause mortality. Secondary outcomes were tricuspid reoperation and valve-related events. Subgroup analyses were performed according to the risk of bias, year of publication and proportions of patients with tricuspid regurgitation Grade ≥3, functional aetiology and isolated tricuspid valve surgery. Publication bias was explored using the funnel plot and Egger's test. RESULTS: Seventeen retrospective studies involving 4561 patients (TVr group = 3432 patients and TVR group = 1129 patients) were included. A pooled analysis showed that the risk of all-cause mortality was significantly higher in the TVR group than in the TVr group [hazard ratio (95% confidence interval) 1.59 (1.26-2.00)]. There were no significant differences in tricuspid valve reoperation in 6 studies and valve-related events in 5 studies between the TVR and TVr groups [hazard ratio (95% confidence interval) 1.30 (0.88-1.91) and 1.47 (0.91-2.38), respectively]. None of the subgroup analyses demonstrated a significant difference in the hazard ratio of all-cause mortality. No publication bias was identified for the primary and secondary outcomes. CONCLUSIONS: This meta-analysis indicates that TVr is more beneficial compared with TVR in terms of all-cause mortality. From the available data, TVr is not associated with an increased risk of tricuspid reoperation compared with TVR.