Tricuspid Valve Replacement: Mechanical or Biological Prostheses? A Systematic Review and Meta-Analysis
DOI:
https://doi.org/10.1532/hsf.3531Keywords:
tricuspid valve replacementAbstract
Background: 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.
Methods: 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).
Results: 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%].
Conclusions: 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.
References
Altaani HA, Jaber S. 2013. Tricuspid Valve Replacement, Mechnical vs. Biological Valve, Which Is Better? Int Cardiovasc Res J. 7(2):71-4.
Calafiore AM, Iaco AL, Romeo A, et al. 2011. Echocardiographicbased treatment of functional tricuspid regurgitation. J Thorac Cardiovasc Surg. 142: 308–13.
Chang BC, Lim SH, Yi G, et al. 2006. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg. 81-(4):1317–1323, discussion 23–4.
Cho WC, Park CB, Kim JB, et al. 2013. Mechanical valve replacement versus bioprosthetic valve replacement in the tricuspid valve position. J Card Surg. 28(3):212-7.
Connolly HM, Schaff HV, Abel MD, et al. 2015. Early and Late Outcomes of Surgical Treatment in Carcinoid Heart Disease. J Am Coll Cardiol. 66(20):2189-96.
Dearani JA. 2014. Editorial comment: lessons learned with tricuspid valve replacement. eur J Cardiothorac surg. 45:90-1.
Easterbrook PJ, Berlin JA, Gopalan R, et al. 1991. Publication bias in clinical research. Lancet (London, England). 337(8746):867-72.
Filsoufi F, Anyanwu AC, Salzberg SP, et al. 2005. Long-term outcomes of tricuspid valve replacement in the current era. Ann Thorac Surg. 80:845–50.
Garatti A, Nano G, Bruschi G, et al. 2012. Twenty-five years outcomes of tricuspid valve replacement comparing mechanical and biologic prostheses. Ann Thorac Surg. 93(4):1146-53.
González-Santos JM, Arnáiz-García ME. 2013. Correcting tricuspid regurgitation: an unresolved issue. Rev Esp Cardiol (Engl Ed). 66: 609–12.
Higgins JPT, Thompson SG, Deeks JJ, et al. 2003. Measuring inconsistency in meta-analyses. BMJ. 327(7414):557-60.
Hwang HY, Kim KH, Kim KB, et al. 2012. Mechanical tricuspid valve replacement is not superior in patients younger than 65 years who need long-term anticoagulation. Ann Thorac Surg. 93(4):1154-60.
Hwang HY, Kim KH, Kim KB, et al. 2014. Propensity score matching analysis of mechanical versus bioprosthetic tricuspid valve replacements. Ann Thorac Surg. 97(4):1294-9.
Hwang HY, Kim KH, Kim KB, et al. 2016. Reoperations after tricuspid valve repair: re-repair versus replacement. J Thorac Dis. 8(1):133-9.
Kaplan M, Kut MS, Demirtas MM, et al. 2002. Prosthetic replacement of tricuspid valve: Bioprosthetic or mechanical. Ann Thorac Surg. 73: 467–73.
Liang W, Yue H, Li T, et al. 2019. The better substitute for tricuspid valve replacement in patients with severe isolated tricuspid regurgitation. Anatol J Cardiol. 22(4):172-6.
Liu P, Qiao WH, Sun FQ, et al. 2016. Should a Mechanical or Biological Prosthesis Be Used for a Tricuspid Valve Replacement? A Meta-Analysis. J Card Surg. 31(5):294-302.
Mao B, Sun L, Zhang J, et al. 2016. Perioperative factors associated with short- and long-term outcomes after tricuspid valve replacement. Interact Cardiovasc Thorac Surg. 23(6):845-50.
McCarthy PM, Bhudia SK, Rajeswaran J, et al. 2004. Tricuspid valve repair: durability and risk factors for failure. J Thorac Cardiovasc Surg. 127: 674–85.
Moher D, Liberati A, Tetzlaff J, et al. 2009. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, BMJ 339. b2535.
Nakano K, Ishibashi-Ueda H, Kobayashi J, et al. 2001. Tricuspid valve replacement with bioprostheses: long-term results and causes of valve dysfunction. Ann Thorac Surg. 71:105–9.
Nickenig G, Kowalski M, Hausleiter J, et al. 2017. Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique. Circulation. 135:1802–14.
Péterffy A, Szentkirályi I. 2001. Mechanical valves in tricuspid position: cause of thrombosis and prevention. Eur J Cardiothorac Surg. 19:735–6.
Ratnatunga CP, Edwards MB, Dore CJ, et al. 1998. Tricuspid valve replacement: UK Heart Valve Registry mid-term results comparing mechanical and biological prostheses. Ann Thorac Surg. 66:1940–7.
Redondo Palacios A, López Menéndez J, Miguelena Hycka J, et al. 2017. Which type of valve should we use in tricuspid position? Long-term comparison between mechanical and biological valves. J Cardiovasc Surg (Torino). 58(5):739-46.
Rizzoli G, De Perini L, Bottio T, et al. 1998. Prosthetic replacement of the tricuspid valve: biological or mechanical? Ann Thorac Surg. 66(Suppl):62–7.
Rizzoli G, Vendramin I, Nesseris G, et al. 2004. Biological or mechanical prostheses in tricuspid position? A meta-analysis of intra-institutional results. Ann Thorac Surg 77(5):1607–14.
Rodríguez-Capitán J, Gómez-Doblas JJ, Fernández-López L, et al. 2013. Short- and long-term outcomes of surgery for severe tricuspid regurgitation. Rev Esp Cardiol (Engl Ed). 66(8):629-35.
Rosser BA, Taramasso M, Maisano F. 2016. Transcatheter interventions for tricuspid regurgitation: TriCinch (4Tech). EuroIntervention. 12:Y110–2.
Songur CM, Simsek E, Ozen A, et al. 2014. Long-term results comparing mechanical and biological prostheses in the tricuspid valve position: which valve types are better--mechanical or biological prostheses? Heart Lung Circ. 23: 1175-8.
Vahanian A, Alfieri O, Andreotti F, et al. 2012. Guidelines on the management of valvular heart disease (version 2012). eur heart J. 33:2451-96.
Van Nooten GJ, Caes FL, Franc¸ois KJ, et al. 1995. The valve choice in tricuspid valve replacement: 25 Years of experience. Eur J Cardiothorac Surg. 9:441–6. Discussion 446–7.
Wiedemann D, Rupprechter V, Mascherbauer J, et al. 2018. Tricuspid valve replacement: results of an orphan procedure - which is the best prosthesis? J Cardiovasc Surg (Torino). 59(4):626-32.
