What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Tricuspid regurgitation (n=3141). Intervention: Rigid ring annuloplasty vs. Flexible band annuloplasty. Primary outcome: Freedom from grade ≥2 tricuspid regurgitation at 5 years (OR 0.44, 95% CI 0.20-0.99).

May 1, 2017Open Access

Flexible band versus rigid ring annuloplasty for tricuspid regurgitation: a systematic review and meta-analysis

Key Result

Rigid ring annuloplasty demonstrated significantly better freedom from grade ≥2 tricuspid regurgitation at 5 years compared to flexible band annuloplasty (OR 0.44).

Study Design

Type

Meta-Analysis (n=3,141)

Structured PICO

Does flexible band annuloplasty compared to rigid ring annuloplasty improve survival and freedom from recurrent tricuspid regurgitation in patients undergoing surgical repair?

Population

Patients undergoing surgical annuloplasty for tricuspid regurgitation

Intervention

Flexible band annuloplasty

Comparator

Rigid ring annuloplasty

Outcome

Short and long term survival and freedom from tricuspid regurgitationhard clinical

Rigid ring annuloplasty provides superior long-term freedom from recurrent tricuspid regurgitation compared to flexible bands, with similar survival and reoperation rates.

Main Result

Effect estimate: OR 0.44 (95% CI 0.20-0.99)

Limitations

The analysis of long term outcomes has been limited to three studies.
All included studies were observational in design and are subject to selection bias.
Different inclusion criteria, operative techniques, and devices may contribute to heterogeneity between studies.

Abstract

BACKGROUND: Up to 20% of patients have pre-discharge residual moderate to severe tricuspid regurgitation (TR) after tricuspid repair. Reoperations for recurrent TR carry high mortality rates, which emphasizes the importance of identifying the optimal technique for the surgical management of TR. The present study is a systematic review and meta-analysis that aims to compare short and long term survival and freedom from TR of flexible band ring versus rigid ring for annuloplasty of TR. METHODS: We conducted a systematic review and meta-analysis of comparative studies to evaluate these procedures. A systematic search of the literature was performed from six electronic databases. Pooled meta-analysis was conducted using odds ratio (OR) and weighted mean difference (WMD). RESULTS: The rates of in-hospital mortality were not different between the two groups, with cumulative rates of 6.9% for flexible band and 7.3% for rigid ring (OR: 0.92; 95% CI: 0.49-1.71). Rates of stroke were also similar with 1.7% of flexible band and 1.3% of rigid rings suffering a perioperative stroke (OR: 1.29; 95% CI: 0.74-2.23). Rigid ring had significantly better freedom from grade ≥2 TR at 5 years (OR: 0.44; 95% CI: 0.20-0.99) and overall (P=0.005). There was no significant difference in overall rates of reoperation (P=0.232) and survival (P=0.086) between flexible band and rigid ring. CONCLUSIONS: Both rigid ring and flexible band offer acceptable outcomes for the treatment of TR. Compared to flexible band, rates of TR are stable after rigid ring annuloplasty and long term freedom from TR are superior for rigid ring devices. Large prospective randomized trials are required in order to validate these findings and assess for improvements in patient survival.

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