Department of Cardiovascular Surgery, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan 610041, China.
Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China; 3The First School of Clinical Medicine, Lanzhou University, Lanzhou 730000, China.
Heart Surg Forum. 2021 Mar 3;24(2):E209-E214. doi: 10.1532/hsf.3531.
Tricuspid valve replacement (TVR) is seldom performed in cardiac valve surgery, and there currently are no clinical guidelines as to which type of prostheses is better in tricuspid valve position. This meta-analysis was performed to compare the results of mechanical and biological prostheses for TVR.
We searched the Pubmed, Cochrane, and Embase clinical trial databases to collect all related studies published from January 1, 2000 to July 31, 2020. A random-effects model was used to evaluate the odds ratios (OR) and its 95% confidence intervals (CI) of time-to-event related effects of the surgical procedures; every study's quality was evaluated by the Newcastle-Ottawa Scale (NOS).
A total of 13 retrospective studies, including 1453 patients were analyzed. There were no statistically differences between mechanical and biological prostheses with respect to prosthetic valve failure [OR = 0.84, 95% CI(0.54, 1.28), P = .41], bleeding [OR = 0.84, 95% CI(0.54,1.28), P = .41], reoperation [OR = 1.02, 95% CI(0.58,1.78), P = .95], early mortality [OR = 1.35, 95% CI(0.82,2.25), P = .24] and long-time survival [OR = 1.09, 95% CI(0.70, 1.69), P = .70], but a significant difference can be seen in mechanical prostheses with a higher risk of thrombosis [OR = 0.17, 95% CI(0.05, 0.60), P = .006, I2 = 0%].
In tricuspid valve position, mechanical valve prostheses have a higher risk of thrombosis than biological prostheses, but no statistical differences between mechanical and biological prostheses with respect to prosthetic valve failure, bleeding, reoperation, early mortality, and long-term survival. The valve disease and patient's age and risk factors are the most important considerations in the decision-making process. The more specific conclusion needs to be further proved by large-sample, multi-center, randomized, double-blind and control trials.
三尖瓣置换术（TVR）在心脏瓣膜手术中很少进行，目前尚无关于哪种类型的假体在三尖瓣位置更好的临床指南。本荟萃分析旨在比较机械和生物假体在 TVR 中的结果。
我们检索了 Pubmed、Cochrane 和 Embase 临床试验数据库，以收集 2000 年 1 月 1 日至 2020 年 7 月 31 日发表的所有相关研究。使用随机效应模型评估手术相关时间事件的优势比（OR）及其 95%置信区间（CI）；使用纽卡斯尔-渥太华量表（NOS）评估每个研究的质量。
共分析了 13 项回顾性研究，包括 1453 例患者。机械和生物假体在假体瓣膜失效方面无统计学差异[OR=0.84，95%CI（0.54，1.28），P=0.41]、出血[OR=0.84，95%CI（0.54，1.28），P=0.41]、再次手术[OR=1.02，95%CI（0.58，1.78），P=0.95]、早期死亡率[OR=1.35，95%CI（0.82，2.25），P=0.24]和长期生存率[OR=1.09，95%CI（0.70，1.69），P=0.70]，但机械假体的血栓形成风险更高[OR=0.17，95%CI（0.05，0.60），P=0.006，I2=0%]。
在三尖瓣位置，机械瓣膜假体的血栓形成风险高于生物假体，但在假体瓣膜失效、出血、再次手术、早期死亡率和长期生存率方面，机械和生物假体之间无统计学差异。瓣膜疾病和患者年龄及危险因素是决策过程中最重要的考虑因素。更具体的结论需要进一步通过大样本、多中心、随机、双盲和对照试验来证明。
