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

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.