Tricuspid valve repair versus a conservative approach in patients with functional tricuspid regurgitation undergoing mitral valve surgery. A systematic review and meta-analysis

Type of funding sources: None.

Tricuspid valve repair (TVR) at the time of mitral valve (MV) surgery is still a debatable part of literature whether to do a concomitant valve repair or not, and if TVR is indicated, whether to perform it in patients with severe functional tricuspid regurgitation (TR) or mild-to-moderate TR. We assessed the benefits of a concomitant TVR during MV surgery, focusing on mortality and echocardiographic TR-related outcomes.

Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of concomitant TVR during MV surgery on all causes, cardiovascular, non-cardiovascular mortality. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated using random-effects models.

27 studies were included for a total of 5460 patients with mean follow up period of 80 months. During MV surgery doing a concomitant TVR has been associated with significant reduction in all-cause mortality (RR: 0.35, 95% CI [0.21 to 0.52], p<0.00001), cardiac-related mortality (RR: 0.34, 95% CI [0.30 to 0.42], p<0.00001), and non-cardiac related mortality (RR: 0.42, 95% CI [0.31 to 0.72], p=0.005). Furthermore, regarding echocardiographic TR outcomes, the presence of more-than-moderate TR (RR: 0.19; 95% CI [0.11–0.34], p = 0.001), TR progression (RR 0.04; 95% CI [0.01–0.07], p =0.001) were significantly lower in the TV repair group at a mean weighted follow-up of 60 months.

A concomitant TVR during MV surgery showed a significant improvement not only in cardiac-related mortality, non-cardiac-related mortality, but also in TR echocardiographic outcomes with long period of follow up.