Transcatheter Tricuspid Valve Replacement for Tricuspid Regurgitation: A Systematic Review and Meta-analysis
Anatolian Journal of Cardiology, cilt.26, sa.7, ss.505-519, 2022 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Derleme
- Cilt numarası: 26 Sayı: 7
- Basım Tarihi: 2022
- Doi Numarası: 10.5152/anatoljcardiol.2022.1440
- Dergi Adı: Anatolian Journal of Cardiology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Academic Search Premier, CINAHL, EMBASE, MEDLINE, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.505-519
- Anahtar Kelimeler: Interventional cardiology, transcatheter tricuspid valve replacement, tricuspid regurgitation
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: The present data aim to evaluate the feasibility of the orthotopic transcatheter tricuspid valve replacement devices, echocardiographic, functional improvements, and mortality rates following replacement in patients with significant tricuspid valve regurgitation. Methods: We systematically searched for the studies evaluating the efficacy and safety of transcatheter tricuspid valve replacement for significant tricuspid valve regurgitation. The efficacy and safety outcomes were the improvements in New York Heart Association functional class, 6-minute walking distance, all-cause death, and periprocedural and long-term complications. In addition, a random-effect meta-analysis was performed comparing outcomes before and after transcatheter tricuspid valve replacement. Results: Nine studies with 321 patients were included. The mean age was 75.8 years, and the mean European System for Cardiac Operative Risk Evaluation II score was 8.2% (95% CI: 6.1 to 10.3). Severe, massive, and torrential tricuspid valve regurgitation was diagnosed in 95% of patients (95% CI: 89% to 98%), and 83% (95% CI: 73% to 90%) of patients were in New York Heart Association functional class III or IV. At a weighted mean follow-up of 122 days, New York Heart Association functional class (risk ratio = 0.20; 95% CI: 0.11 to 0.35; P < .001) and 6-minute walking distance (mean difference = 91.1 m; 95% CI: 37.3 to 144.9 m; P < .001) significantly improved, and similarly, the prevalence of severe or greater tricuspid valve regurgitation was significantly reduced after transcatheter tricuspid valve replacement (baseline risk ratio = 0.19; 95% CI: 0.10 to 0.36; P < .001). In total, 28 patients (10%; 95% CI: 6% to 17%) had died. Pooled analyses demonstrated non-significant differences in hospital and 30-day mortality and >30-day mortality than predicted operative mortality (risk ratio = 1.03; 95% CI: 0.41 to 2.59; P= .95, risk ratio = 1.39; 95% CI: 0.69 to 2.81; P= .35, respectively). Conclusion: Transcatheter tricuspid valve replacement could be an emerging treatment option for patients with severe tricuspid regurgitation who are not eligible for transcatheter repair or surgical replacement because of high surgical risk and poor prognosis.