Tricuspid valve intervention at the time of mitral valve surgery: a meta-analysis

The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. Our objectives were to determine the safety and efficacy of tricuspid valve (TV) repair during mitral valve surgery in a meta-analysis.

MEDLINE and EMBASE were searched from 1946 to 2017 for all studies comparing TV repair to no intervention at the time of mitral valve surgery on early and late mortality and late TR. A random-effects meta-analysis of all outcomes was performed.

One thousand four hundred and seventeen studies were retrieved and a total of 17 studies [2 randomized clinical trial (n = 211), 11 adjusted observational studies (n = 3848) and 4 unadjusted observational studies (n = 67 010)] that compared TV repair (n = 11 787) to no intervention (n = 56 027) at a mean follow-up of 6.0 ± 0.64 years were included. There was no difference in 30-day/in-hospital mortality between repair and no repair [risk ratio (RR) 1.19, 95% confidence interval (95% CI) 0.70-2.02; P = 0.52]. The incidence of new permanent pacemaker implantation was higher in the TV repair group (RR 2.73, 95% CI 2.57-2.89; P < 0.01). TV repair was protective against late moderate or greater TR [incident rate ratio (IRR) 0.28, 95% CI 0.17-0.47; P < 0.01] and severe TR (IRR 0.38, 95% CI 0.17-0.84). There was a numerically lower rate of late TV reoperation (IRR 0.39, 95% CI 0.12-1.25; P = 0.11) that did not reach statistical significance. Overall, there was no difference in late mortality between the 2 treatments (IRR 0.87, 95% CI 0.63-1.24; P = 0.43).

TV repair appears safe in the perioperative period and may reduce future recurrent TR without any survival benefit.