Tricuspid valve repair: A systematic review and meta-analysis of different surgical techniques and their long-term results

OBJECTIVES: The degree of tricuspid regurgitation (TR) is related to mortality. The majority of TR is secondary, and surgery consists mainly of annuloplasty repair (TVr), but repair durability is a prerequisite for a lasting treatment effect. We performed a systematic assessment of TVr durability. METHODS: A systematic literature search was performed (MEDLINE, Cochrane Library and Web of Science). Follow-up of TVr techniques and TR recurrence rates were used to estimate incidence rates which were then meta-analyzed using a single-arm meta-analysis model with random-effects. Comparisons between techniques were performed to obtain incidence rate ratios (IRR) with 95% confidence intervals (CIs). Statistical significance was defined as p < 0.05. RESULTS: A total of 50 studies met the criteria for inclusion (5 randomized and 45 observational), with 15,563 patients, representing 79,763 patient-years (mean follow-up: 3.9 years). Overall recurrence rate was 2.73 per 100 person-years (95% CI 2.15-3.47). Ring annuloplasty had lowest rates (1.81; 95% CI 1.17-2.79), followed by band (2.58; 95% CI 1.66-4.00) and suture (4.06; 95% CI 2.93-5.64). There was a large difference in treatment effects within and between groups (P for interaction=0.011). Compared to suture, ring annuloplasty was associated with lower TR recurrence (IRR 0.45; P = 0.003), but not versus band (IRR 0.71; P = 0.26). There was no difference between band and suture (IRR 0.63; P = 0.12). CONCLUSIONS: Long-term durability of TVr techniques is extremely heterogeneous. We identified the use of rigid rings and flexible bands as being associated with lower recurrence rates compared to suture techniques.