OBJECTIVE. For many years, functional tricuspid regurgitation (FTR) was
considered negligible after treatment of left-sided heart valve surgery.
The aim of the present network meta-analysis is to summarize the results
of four approaches in order to establish the possible gold standard.
METHODS A systematic search was performed to identify all publications
reporting the outcomes of four approach for FTR, not tricuspid
annuloplasty (no TA), suture annuloplasty (SA), flexible (FRA), rigid
rings (RRA). All studies reporting at least one the four endpoints
(early and late mortality, early and late moderate or more TFR) were
included in a Bayesian network meta-analysis. RESULTS There were 31
included studies with 9,663 patients. Aggregate early mortality was
5.3% no TA, 7.2% SA, 6.6% FRA and 6.4% RRA; Early TR
moderate-or-more was 9.6%, 4.8%, 4.6% and 3.8%; Late mortality was
22.5%, 18.2%, 11.9% and 11.9%; Late TR moderate-or-more was 27.9%,
18.3%, 14.3% and 6.4%. Rigid or semirigid ring annuloplasty was the
most effective approach for decreasing the risk of late moderate or more
FTR (–85% vs. no TA; –64% vs. SA; –32% vs. FRA). Concerning late
mortality, no significant differences were found among different
surgical approaches, however, flexible or rigid rings reduced
significantly the risk of late mortality (78% and 47%, respectively)
compared with not performing TA mortality. No differences were found for
early outcomes. CONCLUSIONS. Ring annuloplasty seems to offer better
late outcomes compare to either suture annuloplasty or not performing
TA. In particular rigid or semirigid rings provides more stable FTR
across time.
Role of concomitant tricuspid surgery in moderate functional tricuspid regurgitation in patients undergoing left heart valve surgery
