Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan.
Department of Biochemistry, Jinnah Sindh Medical University, Karachi, Pakistan.
J Cardiothorac Surg. 2024 Nov 26;19(1):636. doi: 10.1186/s13019-024-03014-0.
Tricuspid valve replacement (TVR) is required when repair is not feasible, and it continues to be a relatively high-risk procedure owing to the complex medical and/or surgical profile of patients. The choice between mechanical and biological prostheses for TVR remains a subject of debate owing to their distinct advantages and disadvantages. This study aimed to analyse and compare the clinical outcomes of these two types of prostheses in the tricuspid position.
PubMed, EMBASE, Web of Science, and the COCHRANE library were searched from 1995 to April 2023 for studies comparing clinical outcomes of mechanical versus biological valves in the tricuspid position. Data on 30-day mortality, reoperations, 5-year valve failure rates, thrombotic/thromboembolic events, and long-term survival were extracted, pooled, and analysed. Forest plots were generated using a random-effects model.
From an initial pool of 4716 citations, 37 studies meeting our inclusion criteria were assessed, collectively encompassing 8316 prostheses (3796 mechanical, 4520 bioprostheses). Our analysis revealed that mechanical valves exhibited a non-significant trend towards diminished 30-day mortality (RR = 0.85, 95% CI = 0.69-1.06). A distinct disparity emerged in valve durability, with mechanical valves demonstrating a significantly increased risk of 5-year valve failure (RR = 2.21, 95% CI = 1.38-3.56). Strikingly, mechanical valves displayed a substantial six-fold elevated risk of thrombotic events (RR = 6.29, 95% CI = 3.98-9.92). In contrast, the long-term survival and reoperation rates demonstrated no statistically significant differences between the two valve types.
This systematic review and meta-analysis provides insights into the selection of mechanical and bioprosthetic valves for TVR. These findings highlight the potential advantages and disadvantages of mechanical and bioprosthetic valves in terms of early mortality, valve durability, and thrombotic risk. Our analysis provides clinicians with evidence-based guidance for optimizing outcomes in TVR, offering a foundation for informed decision-making in this intricate surgical landscape. Despite these insights, clinicians must overcome the limitations of retrospective studies, evolving healthcare, and anticoagulant disparities to ensure careful consideration in tricuspid valve replacement decisions.
当修复不可行时，需要进行三尖瓣置换术（TVR），由于患者的复杂医疗和/或手术情况，该手术仍然是一个相对高风险的程序。由于机械和生物假体各有优缺点，因此对于 TVR 应选择哪种假体仍然存在争议。本研究旨在分析和比较这两种假体在三尖瓣位置的临床结果。
从 1995 年至 2023 年 4 月，通过 PubMed、EMBASE、Web of Science 和 COCHRANE 图书馆检索比较机械与生物瓣膜在三尖瓣位置的临床结果的研究。提取、汇总和分析 30 天死亡率、再次手术、5 年瓣膜失败率、血栓形成/栓塞事件和长期生存率的数据。使用随机效应模型生成森林图。
从最初的 4716 条引文库中，有 37 项符合纳入标准的研究被评估，总共包括 8316 个假体（3796 个机械，4520 个生物假体）。我们的分析表明，机械瓣膜在 30 天死亡率方面呈现出无显著意义的降低趋势（RR=0.85，95%CI=0.69-1.06）。瓣膜耐久性方面存在明显差异，机械瓣膜的 5 年瓣膜失败风险显著增加（RR=2.21，95%CI=1.38-3.56）。值得注意的是，机械瓣膜发生血栓事件的风险显著增加了六倍（RR=6.29，95%CI=3.98-9.92）。相比之下，两种瓣膜类型的长期生存率和再次手术率没有统计学上的显著差异。
本系统评价和荟萃分析提供了机械和生物假体选择用于 TVR 的见解。这些发现突出了机械和生物假体在早期死亡率、瓣膜耐久性和血栓风险方面的潜在优势和劣势。我们的分析为临床医生提供了 TVR 优化结果的循证指导，为在这个复杂的手术领域中做出明智决策提供了基础。尽管有这些见解，但临床医生必须克服回顾性研究、不断发展的医疗保健和抗凝剂差异的局限性，以确保在三尖瓣置换决策中进行仔细考虑。
