Rigid Ring versus Flexible Band for Functional Tricuspid Regurgitation? Long-Term Survival and Tricuspid Regurgitation Recurrence Using Reconstructed Individual Patient Data Time-to-Event Analysis

Objectives To compare long-term survival and recurrent tricuspid regurgitation (TR) following tricuspid valve repair (TVr) using flexible bands versus rigid rings for functional TR. Design Systematic review and reconstructed individual patient data (IPD) meta-analysis with parallel study-level random-effects meta-analysis. Setting Meta-analysis of published studies identified through PubMed, Scopus, and the Cochrane Library. Participants A total of 4,407 adult patients from 11 studies undergoing TVr for functional TR; 59% received flexible bands. Interventions Comparison of flexible band versus rigid ring annuloplasty. Time-to-event data were reconstructed from published Kaplan–Meier curves, and pooled hazard ratios were estimated using Cox frailty models. Propensity-matched subgroup analyses were performed. Measurements and Main Results Primary outcome was long-term survival; secondary outcome was freedom from recurrent TR. Study-level meta-analysis showed no significant difference in survival between device types [HR 0.86; 95% CI 0.72 to 1.04; p = 0.110]. In contrast, reconstructed IPD analysis demonstrated an association between flexible bands and improved long-term survival compared with rigid rings [HR 0.76; 95% CI 0.65 to 0.89; p < 0.001] and greater freedom from recurrent TR [HR 0.62, 95% CI 0.48 to 0.80; p < 0.001]. No significant differences were observed in propensity-matched cohorts. Conclusions Reconstructed IPD analyses demonstrated associations between flexible bands and improved long-term survival and greater freedom from recurrent TR; however, these associations were not confirmed in study-level or propensity-matched analyses. The available evidence therefore does not establish superiority of either annuloplasty strategy.