Long-term outcomes of surgical repair versus replacement for tricuspid valve endocarditis − A meta-analysis of reconstructed time-to-event data

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2025-08-28 DOI:10.1016/j.ijcha.2025.101782

Eric Katsuyama , Christian Fukunaga , Felipe S. Passos , Nicole Lee , Ana Carolina Ventura de Santana de Jesus , Camila M. Ydy , Sofia Junqueira Franco Massuda , Hristo Kirov , Torsten Doenst , Tulio Caldonazo

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引用次数: 0

Abstract

Introduction

Tricuspid valve infective endocarditis (TVIE) is surgically managed by tricuspid valve repair (TVr) or replacement (TVR). However, the differences in long-term endpoints and perioperative complications between the two strategies remain unclear. Therefore, this updated meta-analysis aimed to evaluate the efficacy and safety of TVr compared with TVR.

Methods

MEDLINE, EMBASE, Cochrane Library, LILACS, and ClinicalTrials.gov were searched. The endpoints of interest were long-term all-cause mortality (primary), any reoperation, reinfection, postoperative stroke, and postoperative acute kidney injury (AKI). Data are reported as hazard ratios (HR) and odds ratios (OR) with their respective 95% confidence intervals (CI).

Results

We included 19 retrospective cohorts comprising 9,734 patients, of which 59.7 % received TVr and 74.3 % were intravenous drug users. One study was risk-adjusted. The median age and follow-up were 35.9 years and 3.9 years, respectively. Compared with TVR, TVr was associated with lower long-term mortality (HR: 0.77; 95 %CI: 0.60 to 0.98; P = 0.04) and lower odds of any reoperation (OR: 0.73; 95 %CI: 0.60 to 0.89; P < 0.01), reinfection (OR: 0.40; 95 %CI: 0.19 to 0.86; P = 0.02), and postoperative AKI (OR: 0.79; 95 %CI: 0.68 to 0.92; P < 0.01). No differences were found in postoperative stroke (OR: 1.17; 95 %CI: 0.83 to 1.65; P = 0.41).

Conclusion

In this meta-analysis, TVr improved overall survival and reduced postoperative complications in patients with TVIE. A possible treatment allocation bias needs to be considered as a potential concern of series with observational nature.

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三尖瓣心内膜炎手术修复与置换术的长期结果-重建时间-事件数据的荟萃分析

三尖瓣感染性心内膜炎（TVIE）通过三尖瓣修复（TVr）或置换术（TVr）进行手术治疗。然而，两种策略在长期终点和围手术期并发症方面的差异尚不清楚。因此，这项更新的荟萃分析旨在评估TVr与TVr的疗效和安全性。方法检索medline、EMBASE、Cochrane Library、LILACS和ClinicalTrials.gov。感兴趣的终点是长期全因死亡率（主要），任何再手术，再感染，术后卒中和术后急性肾损伤（AKI）。数据以风险比（HR）和优势比（OR）及其各自的95%置信区间（CI）报告。结果纳入19个回顾性队列，共9734例患者，其中59.7%接受TVr治疗，74.3%为静脉吸毒者。一项研究是风险调整的。中位年龄和随访时间分别为35.9岁和3.9岁。与TVR相比，TVR与较低的长期死亡率（HR: 0.77; 95% CI: 0.60 ~ 0.98; P = 0.04）、较低的再手术几率（OR: 0.73; 95% CI: 0.60 ~ 0.89; P < 0.01）、再感染（OR: 0.40; 95% CI: 0.19 ~ 0.86; P = 0.02）和术后AKI （OR: 0.79; 95% CI: 0.68 ~ 0.92; P < 0.01）相关。术后卒中发生率无差异（OR: 1.17; 95% CI: 0.83 ~ 1.65; P = 0.41）。结论：在这项荟萃分析中，TVr提高了TVIE患者的总生存率，减少了术后并发症。一个可能的治疗分配偏倚需要考虑作为一个潜在的关注系列具有观察性。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.