Repair of Less Than Severe Tricuspid Regurgitation during Left Sided Valve Surgery: A Meta-Analysis

Abstract Background To undertake a systematic review and meta-analysis investigating the short and long-term clinical outcomes of concurrent repair of mild or moderate tricuspid regurgitation during left sided valve surgery. Methods Medline, PubMed, EMBASE and Cochrane Libraries were searched and 12 studies were identified, comprising 1,373 repair and 1,553 non-repair patients. Of these, six studies were classified as low risk of bias (randomized controlled trials or propensity matched studies) and six at high risk of bias (non-matched observational studies). The primary analysis included only low risk of bias studies (399 repair and 426 non-repair). Results Primary analysis of studies at low risk of bias demonstrated that the addition of tricuspid repair compared to non-repair was associated with reduced risks of cardiovascular mortality, all-cause mortality and progression of tricuspid regurgitation over a median of 5.3 years follow up (cardiovascular mortality: RR=0.46, 95% CI: 0.28-0.75, p=0.002; all-cause mortality: RR=0.68, 95% CI: 0.49-0.96, p=0.03; TR progression: RR=0.26, 95% CI: 0.12-0.56, p 0.05) Conclusions Concurrent repair of mild or moderate tricuspid regurgitation during left sided valve surgery is associated with improved long-term clinical outcomes, without adversely impacting on early survival. Should these results be validated by ongoing trials, there should be revision of current guidelines to recommend more aggressive approach towards repair.