Tricuspid valve detachment for ventricular septal defect closure: A
meta-analysis of existing evidence
Abstract
Background: Ventricular septal defect (VSD) is one of the most
common congenital cardiac defects, However, in some cases VSD sites are
difficult to expose due to obstruction from chordal attachments and
leaflets of the tricuspid valve (TV)[6](#ref-0006). To
systematically review the efficacy and safety of tricuspid valve
detachment,( TVD) versus conventional surgical repair ( non-TVD) in the
treatment of ventricular septal defect ( VSD) .This article is aimed to
compare the many outcomes from existing studies and provide evidence
regarding the necessity of performing TVD. Methods:We searched
the following databases: PubMed via NCBI, the Cochrane Central Register
of Controlled Trials (no date restriction),Medline via Ovid (from 1966
to May 2020); Embase via Ovid (no date restriction) and China National
Knowledge Infrastructure for studies comparing the efficacy of tricuspid
valve detachment (TVD) and other surgical techniques in VSD repair.
Cardiopulmonary bypass time, Cross-clamp time; postoperative
complications including residual defect ,Postoperative atrioventricular
block ,Implantation of pacemakers, tricuspid regurgitation ;Length of
stay, Length of ICU stay were analyzed. Results: Only 9
studies were included after selection (Table 1), including 7
retrospective cohort studies, 1 respective cohort study and 1
prospective observational stud,a patient pool of 1404 patients with 374
underwent TVD and 1030 underwent non-TVD procedures,met the inclusion
criteria.Meta analysis has drawn to the following conclusions. Firstly,
TVD prolongs CPB time (MD=7.75, 95% CI=2.60-12.89, p=0.003) and
cross-clamp time(MD=7.77, 95% CI=4.76-10.78, p<0.001)
compared with non-TVD techniques in VSD repair surgeries. Secondly, no
significant difference exists in LOS, length of ICU stay, postoperative
atrioventricular block, implantation of pacemakers, incidence of ≥mild
TR postoperatively and at discharge, as well as incidence of ≥small
residual VSD after surgery and during follow-up( all P > 0.
05). Thirdly, application of TVD increases the risk of TR during
follow-up(OR=2.42, 95% CI=1.55-3.76, p<0.001).
Conclusion: VSD closure using TVD technique results in longer
CPB and cross-clamp time, and increases risk of TR during follow-up. TVD
provides equally viable and safe alternative in treating VSD.