Long-Term Outcomes of Tricuspid Valve Replacement With Mechanical Versus Tissue Valves: Meta-Analysis of Reconstructed Time-to-Event Data

• Published in: The American journal of cardiology Vol. 225; pp. 89 - 97
• Main Authors: Sá, Michel Pompeu, Iyanna, Nidhi, Tabrizi, Nika Samadzadeh, Jacquemyn, Xander, Ahmad, Danial, Brown, James A., Yousef, Sarah, Serna-Gallegos, Derek, Yoon, Pyongsoo D., Sultan, Ibrahim
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.08.2024; Elsevier Limited
• Subjects: Bioprosthesis; cardiac surgical procedures; cardiovascular surgical procedures; Confidence intervals; Data analysis; Death; Digitization; Endocarditis; Fibrillation; Frailty; Heart; heart valve diseases; Heart Valve Diseases - surgery; Heart Valve Prosthesis; heart valve prosthesis implantation; Heart Valve Prosthesis Implantation - methods; Humans; Long-term effects; Mean square errors; Meta-analysis; Patients; Prostheses; Prosthesis Design; Regression analysis; Reoperation - statistics & numerical data; Risk acceptance; Statistical analysis; Surgery; Survival; Time Factors; Treatment Outcome; Tricuspid valve; Tricuspid Valve - surgery; tricuspid valve replacement; meta-analysis; heart valve diseases; tricuspid valve replacement; heart valve prosthesis implantation; cardiac surgical procedures; cardiovascular surgical procedures
• DOI: 10.1016/j.amjcard.2024.06.010
• ISSN: 0002-9149; 1879-1913

Tricuspid valve replacement (TVR) with mechanical versus tissue valves remains a controversial subject. To evaluate the long-term effects of types of valves on patient-relevant outcomes, we performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 15, 2024 (according to referred the Reporting Items for Systematic Reviews and Meta-analyses guidelines). A total of 21 studies met our eligibility criteria and included 7,166 patients (mechanical: 2,495 patients, 34.8%). Patients who underwent mechanical TVR had a lower risk of death than those who received a tissue valve (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.70 to 0.84, p <0.001). Mechanical TVR was associated with lifetime gain, as evidenced by the restricted mean survival time, which was 2.2 years longer in patients who underwent TVR with mechanical valves (12.4 vs 10.2 years, p <0.001). Our landmark analysis for reoperations revealed the following: from the time point 0 to 7 years, we found no difference in the risk of reoperation between mechanical and tissues valves (HR 0.98, 95% CI 0.60 to 1.61, p = 0.946); however, from the time point 7 years onward, we found that mechanical TVR had a lower risk of reoperation in the follow-up (HR 0.24, 95% CI 0.08 to 0.72, p = 0.001). The meta-regression analysis demonstrated a modulating effect of atrial fibrillation on the association between mechanical valves and mortality; the HRs for all-cause death tended to decrease in the presence of populations with a larger proportion of atrial fibrillation (p = 0.018). In conclusion, our results suggest that TVR with mechanical valves, whenever considered clinically reasonable and accepted by patients as an option, can offer a better long-term survival and lower risk of reoperation in the long run.