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Tricuspid valve detachment for ventricular septal defect closure: A meta-analysis of existing evidence
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  • Dou Yuan,
  • Li ping Chen,
  • Xiao ling,
  • Yongjun Qian
Dou Yuan
Sichuan University West China Hospital

Corresponding Author:[email protected]

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Li ping Chen
Sichuan University West China Hospital
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Xiao ling
Sichuan University West China Hospital
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Yongjun Qian
Sichuan University West China Hospital
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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.
29 Aug 2022Submitted to Journal of Cardiac Surgery
29 Aug 2022Submission Checks Completed
29 Aug 2022Assigned to Editor
01 Oct 2022Review(s) Completed, Editorial Evaluation Pending
02 Oct 2022Editorial Decision: Revise Major
31 Oct 20221st Revision Received
31 Oct 2022Submission Checks Completed
31 Oct 2022Assigned to Editor
31 Oct 2022Review(s) Completed, Editorial Evaluation Pending
31 Oct 2022Editorial Decision: Accept
Dec 2022Published in Journal of Cardiac Surgery volume 37 issue 12 on pages 5395-5403. 10.1111/jocs.17214