REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 October;63(5):624-31

DOI: 10.23736/S0021-9509.22.12354-2

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Concomitant tricuspid annuloplasty in patients with mild to moderate tricuspid valve regurgitation undergoing mitral valve surgery: meta-analysis

Yujiro YOKOYAMA ¹, Junji TSUKAGOSHI ², Hisato TAKAGI ³, Hiroo TAKAYAMA ⁴, Toshiki KUNO ⁵ ✉

¹ Department of Surgery, St. Luke’s University Health Network, Bethlehem, PA, USA; ² Department of Surgery, University of Texas Medical Branch, Galveston, TX, USA; ³ Department of Cardiovascular Surgery, Shizuoka Medical Center, Shizuoka, Japan; ⁴ Department of Surgery, Columbia University Medical Center, New York, NY, USA; ⁵ Department of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY, USA

INTRODUCTION: Clinical effects of concomitant tricuspid annuloplasty (TA) in patients with mild to moderate tricuspid regurgitation at the time of mitral valve surgery (MVS) remains indefinite. We aimed to perform a meta-analysis to determine the long-term clinical and echocardiographic effects of concomitant TA in patients undergoing MVS.
EVIDENCE ACQUISITION: MEDLINE and EMBASE were searched through January 2022 to identify randomized controlled trials (RCT) and observational studies with adjusted outcomes that investigated outcomes of concomitant TA versus conservative management for mild to moderate tricuspid regurgitation in patients undergoing MVS.
EVIDENCE SYNTHESIS: Two RCT and 11 observational studies included in the meta-analysis with a total of 3,953 patients underwent MVS with (N.=1837) or without (N.=2166) concomitant TA. Mean follow-up period ranged from 24 to 115.5 months. MVS with concomitant TA was associated with all-cause mortality (hazard ratio [HR] 1.15; 95% confidence interval [CI]: 0.81-1.55; P=0.34, I²=0%) compared with MVS alone. Similarly, heart failure events (HR 0.74; 95% CI: 0.46-1.20; P=0.22, I²=0%) as well as rates of tricuspid reoperation (HR 0.55; 95% CI: 0.27-1.10; P=0.09, I²=1%) were comparable between the groups. However, MVS with concomitant TA was associated with a significant reduction in TR progression (HR 0.30; 95% CI: 0.17-0.53; P<0.00001, I²=11%).
CONCLUSIONS: Concomitant TA for patients undergoing MVS was associated with similar long-term clinical outcomes compared to MVS alone. However, concomitant TA was associated with a significant reduction in TR progression. Longer follow-up is necessary to assess the effect on further clinical outcomes.

KEY WORDS: Mitral valve, surgery; Tricuspid valve insufficiency; Cardiac valve annuloplasty