Yasmin Farah, Najeeb Hala, Naeem Unaiza, Moeed Abdul, Zaidi Farwa, Asghar Muhammad Sohaib, Aamir Muhammad
Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN.
Curr Probl Cardiol. 2022 Dec;47(12):101360. doi: 10.1016/j.cpcardiol.2022.101360. Epub 2022 Aug 23.
Tricuspid valve repair (TVR) is recommended for patients with moderate primary tricuspid regurgitation (TR), those with moderate TR, and a history of heart failure without annular dilation, while being essential for patients with severe secondary TR undergoing MVS. The meta-analysis aimed to evaluate the efficacy and safety of tricuspid valve repair in patients undergoing MVS. We systematically searched PubMed, Embase, and Google Scholar through January 2022, and studies comparing patients with TVR and those without TVR were selected. The primary outcomes were 30-day, and all-cause mortality. In this meta-analysis, 20 studies were included with a patient population of 72,422. No significant differences were observed between patients undergoing TVR with MVS, in comparison to MVS group only for the primary outcomes i.e., 30-day mortality (RR: 1.14, 95% CI [0.69, 1.87], and all-cause mortality (RR: 1.16, 95% CI [0.86, 1.57]. From the secondary outcomes, pacemaker insertion (RR: 2.62, 95% CI [2.24, 3.06]), new-onset TR or progression (RR: 0.32, 95% CI [0.16, 0.66]), stroke (RR: 1.22, 95% CI [1.05, 1.42]), cross-clamp time (WMD: 17.67, 95% CI [13.96, 21.37]), surgery time (WMD: 43.59, 95% CI [37.07, 50.10]), ICU time (WMD: 19.50, 95% CI [9.31, 29.67]), and ventilation time (WMD: 6.62, 95% CI [0.69, 12.55]) were significant. However, major bleeding events, atrial fibrillation, renal failure, heart failure hospitalization, postoperative MI, wound infection, early or prolonged morbidity, cardiopulmonary bypass time, and duration of hospital stay were non-significant. Our meta-analysis has furthered the discussion for weighing the risks and benefits of pursuing TVR during MVS.
对于中度原发性三尖瓣反流（TR）患者、中度TR且无瓣环扩张的心力衰竭病史患者，推荐进行三尖瓣修复术（TVR），而对于接受二尖瓣置换术（MVS）的重度继发性TR患者，TVR至关重要。这项荟萃分析旨在评估TVR在接受MVS患者中的疗效和安全性。我们系统检索了截至2022年1月的PubMed、Embase和谷歌学术，选取了比较TVR患者和未接受TVR患者的研究。主要结局为30天全因死亡率。在这项荟萃分析中，纳入了20项研究，患者总数为72422例。在接受TVR联合MVS的患者与仅接受MVS的患者之间，就主要结局而言，即30天死亡率（风险比[RR]：1.14，95%置信区间[CI][0.69，1.87]）和全因死亡率（RR：1.16，95%CI[0.86，1.57]），未观察到显著差异。在次要结局方面，起搏器植入（RR：2.62，95%CI[2.24，3.06]）、新发TR或进展（RR：0.32，95%CI[0.16，0.66]）、中风（RR：1.22，95%CI[1.05，1.42]）、主动脉阻断时间（加权均数差[WMD]：17.67，95%CI[13.96，21.37]）、手术时间（WMD：43.59，95%CI[37.07，50.10]）、重症监护病房（ICU）时间（WMD：19.50，95%CI[9.31，29.67]）和通气时间（WMD：6.62，95%CI[0.69，12.55]）有显著差异。然而，严重出血事件、心房颤动、肾衰竭、心力衰竭住院、术后心肌梗死、伤口感染、早期或长期发病率、体外循环时间和住院时间无显著差异。我们的荟萃分析进一步推动了关于权衡在MVS期间进行TVR的风险和益处的讨论。
