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The best approach for functional tricuspid regurgitation. A network meta-analysis.
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  • Michele Di Mauro,
  • Roberto Lorusso,
  • Alessandro Parolari,
  • Justine Ravaux,
  • Giorgia Bonalumi,
  • Stefano Guarracini,
  • Fabrizio Ricci,
  • Umberto Benedetto,
  • Antonio Calafiore
Michele Di Mauro
Maastricht UMC+
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Roberto Lorusso
Maastricht UMC+
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Alessandro Parolari
Istituto Policlinico San Donato
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Justine Ravaux
Maastricht UMC+
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Giorgia Bonalumi
Centro Cardiologico Monzino Istituto di Ricovero e Cura a Carattere Scientifico
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Stefano Guarracini
Private Hospital Pierangeli Srl
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Fabrizio Ricci
Università degli Studi Gabriele d'Annunzio Chieti Pescara Dipartimento di Scienze
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Umberto Benedetto
Bristol Heart Institute, University of Bristol, Upper Maudlin St, Bristol BS2 8HW
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Antonio Calafiore
Gemelli Molise
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Abstract

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.

Peer review status:ACCEPTED

21 Nov 2020Submitted to Journal of Cardiac Surgery
28 Nov 2020Submission Checks Completed
28 Nov 2020Assigned to Editor
30 Nov 2020Reviewer(s) Assigned
21 Dec 2020Review(s) Completed, Editorial Evaluation Pending
22 Dec 2020Editorial Decision: Revise Major
24 Dec 20201st Revision Received
26 Dec 2020Submission Checks Completed
26 Dec 2020Assigned to Editor
27 Dec 2020Review(s) Completed, Editorial Evaluation Pending
04 Jan 2021Reviewer(s) Assigned
16 Jan 2021Editorial Decision: Accept