Isolated surgical tricuspid valve replacement had an overall operative mortality rate of 12% (95% CI: 9-15), with higher mortality in patients operated on before 1995 or with prior cardiac surgery.
Meta-Analysis (n=5,316)
Yes
Isolated surgical tricuspid valve replacement is associated with a 12% operative mortality and significant early complications, providing a historical benchmark for future transcatheter tricuspid valve replacement trials.
BACKGROUND: Transcatheter tricuspid valve replacement (TTVR) is rapidly emerging as a therapeutic option amongst patients with secondary tricuspid regurgitation. Historical data from surgical tricuspid valve replacement (TVR) studies may serve as a benchmark for the development of TTVR trials. AIMS: The aim of the study was to investigate the early and late outcomes following isolated surgical TVR. METHODS: Multiple electronic databases were searched to identify studies on isolated surgical TVR. The prespecified primary endpoint was operative mortality; secondary endpoints were early and late outcomes. Overall estimates of proportions and incidence rates with 95% confidence intervals (CI) were calculated using random-effects models. Multiple sensitivity analyses accounting for baseline characteristics, country and the operative period were applied. Results: A total of 35 studies (5,316 patients) were included in this meta-analysis. The operative period ranged from 1974 to 2019. The overall rate of operative mortality was 12% (95% CI: 9-15), with higher mortality for patients who were operated on before 1995, who had prior cardiac surgeries, or who had liver disease. The most frequent clinical events were pacemaker implantation (10% 95% CI: 6-16), bleeding (12% 95% CI: 8-17), acute kidney injury (15% 95% CI: 9-24) and respiratory complications (15% 95% CI: 12-20). At follow-up analysis of the bioprosthetic TVR, there was an incidence rate per 100 person-years of 6 (95% CI: 2-13) for death and 8 (95% CI: 5-13) for recurrence of significant tricuspid regurgitation. CONCLUSIONS: This meta-analysis provides an overview of the historical clinical outcomes following isolated surgical TVR. These findings can support the development of future clinical trials in the tricuspid space by providing thresholds for clinical outcomes.
Scotti et al. (2022) conducted a meta-analysis in secondary tricuspid regurgitation (n=5,316). Isolated surgical tricuspid valve replacement was evaluated on operative mortality (95% CI 9-15). Isolated surgical tricuspid valve replacement had an overall operative mortality rate of 12% (95% CI: 9-15), with higher mortality in patients operated on before 1995 or with prior cardiac surgery.