Cardiothoracic Surgery Department, Tanta University, Egypt.
Cardiothoracic Surgery Department, Tanta University, Egypt.
Heart Lung Circ. 2021 Mar;30(3):362-371. doi: 10.1016/j.hlc.2020.03.011. Epub 2020 Apr 1.
The ideal prosthesis for tricuspid valve replacement (TVR) continues to be debated. There are few published data comparing mechanical and bioprosthetic valves, and all are retrospective studies with relatively small sample sizes.
This study was conducted to compare mechanical and bioprosthetic valves for TVR.
A literature search of six databases (PubMed, EMBASE, Ovid, ScienceDirect, JSTOR, and Wiley Blackwell's online library) was performed with the keywords "tricuspid valve disease, tricuspid valve replacement and (bioprosthetic or mechanical)". Primary outcomes were hospital mortality, long-term survival, tricuspid valve reoperation, valve failure, thrombosis, and thrombo-embolism. Risk ratio (RR) was used to compare dichotomous parameters and time-to-event outcomes. "Survival and re-interventions" were pooled using a meta-analysis of hazard ratios (HR). Publication bias was accessed using a funnel plot.
A total of 23 retrospective studies involving 945 mechanical and 1,332 biological tricuspid prostheses were included. The studies were published between January 2002 and September 2019. Hospital mortality (30-day mortality) did not differ between groups (RR, 0.83; 95% confidence interval [CI], 0.66-1.05; p=0.12). Long-term survival was evaluated in 15 studies, and it was not significantly different between patients with mechanical compared with those with bioprosthetic valves (pooled HR, 0.97; 95% CI, 0.61-1.54; p=0.88). Freedom from tricuspid valve reoperation was assessed in eight studies, and no difference was found between the groups (pooled HR, 1.03; 95% CI, 0.63-1.69; p=0.89). Valve failure in the 5-year postoperative period was evaluated by seven studies, and there was no statistically significant difference between the two groups (pooled RR, 1.33; 95% CI, 0.42-4.27; p=0.63).
The results of this meta-analysis suggest an equal risk of 30-day and late mortality, reoperation, and 5-year valve failure in patients with mechanical versus biological TVR. The choice of the prosthesis in the tricuspid position should depend mainly on the patient's risk factors and no superiority of one prosthesis over the other in this position.
三尖瓣置换术（TVR）的理想假体仍存在争议。很少有发表的数据比较机械瓣膜和生物瓣膜，而且所有数据都是回顾性研究，样本量相对较小。
本研究旨在比较 TVR 中使用机械瓣膜和生物瓣膜的效果。
通过关键词“三尖瓣疾病、三尖瓣置换和（生物假体或机械假体）”在六个数据库（PubMed、EMBASE、Ovid、ScienceDirect、JSTOR 和 Wiley Blackwell 的在线图书馆）中进行文献检索。主要结局包括住院死亡率、长期生存率、三尖瓣再手术、瓣膜衰竭、血栓形成和血栓栓塞。使用风险比（RR）比较二项参数和时间事件结局。使用危险比（HR）的荟萃分析对“生存和再干预”进行汇总。使用漏斗图评估发表偏倚。
共纳入 23 项回顾性研究，涉及 945 例机械瓣膜和 1332 例生物三尖瓣假体。这些研究发表于 2002 年 1 月至 2019 年 9 月之间。两组之间的住院死亡率（30 天死亡率）无差异（RR，0.83；95%置信区间 [CI]，0.66-1.05；p=0.12）。15 项研究评估了长期生存率，机械瓣膜组与生物瓣膜组之间的生存率无显著差异（合并 HR，0.97；95%CI，0.61-1.54；p=0.88）。8 项研究评估了 5 年内的三尖瓣再手术无失败率，两组之间无差异（合并 HR，1.03；95%CI，0.63-1.69；p=0.89）。7 项研究评估了术后 5 年内瓣膜衰竭的发生率，两组之间无统计学显著差异（合并 RR，1.33；95%CI，0.42-4.27；p=0.63）。
这项荟萃分析的结果表明，机械瓣膜和生物瓣膜组患者的 30 天和晚期死亡率、再手术和 5 年瓣膜衰竭的风险相等。三尖瓣位置的假体选择应主要取决于患者的风险因素，而在该位置上一种假体并不比另一种假体具有优势。
