P1598Tricuspid valve repair at the time of mitral valve surgery is safe and reduces the incidence of late tricuspid regurgitation and reoperation: a meta-analysis
Bibliographic record
Abstract
Background: The surgical management of tricuspid regurgitation (TR) at the time of mitral valve surgery remains controversial. The incidence of tricuspid valve repair (TVR) during mitral valve surgery ranges from 7% to 65% in the literature. Our objectives were to determine the safety and efficacy of TVR during mitral valve repair or replacement in a meta-analysis. Methods: MEDLINE and EMBASE was searched from 1946 to 2017 for all studies comparing TVR (TVR+) to no TVR (TVR−) at the time of mitral valve surgery on early and late mortality and late TR. A random-effects meta-analysis of all outcomes was performed. Short term binary outcomes were pooled as risk ratios (RR) and late outcomes were pooled as incident rate ratios (IRR) to account for differences in follow-up between groups. Results: 1417 studies were retrieved and a total of 19 studies (one randomized clinical trial (RCT, n=44), six adjusted observational studies (n=2389) and 12 unadjusted observational studies (n=67,814)) were included in the final analysis that compared TVR+ (n=11,787) to TVR− (n=56,027) at a mean follow-up of 5.0 years. The indication(s) for TVR were: any TR with an enlarged annulus (n=6), moderate or less TR (n=5), moderate or more (n=5), any TR (n=3). The majority of patients underwent repair with an annuloplasty ring while a minority underwent suture annuloplasty. There was no difference in 30-day/in-hospital mortality between TVR+ and TVR− (RR: 1.31 95% confidence interval (95% CI): 0.85, 2.02, p=0.25). The incidence of new permanent pacemaker implantation was higher in the TVR+ group (RR: 2.73, 95% CI: 2.57, 2.89, p<0.01). TVR+ was protective against late moderate to severe TR (IRR: 0.26, 95% CI: 0.16, 0.43; p<0.01) and severe TR (IRR: 0.32, 95% CI: 0.11, 0.91, p=0.03). There was a trend towards a lower rate of late TV reoperation in a pooled analysis of five studies (IRR: 0.36, 95% CI: 0.13,1.02; p=0.06). Overall, there was no difference in late mortality between TVR+ and TVR− (Figure – IRR: 0.87, 95% CI: 0.63, 1.20 p=0.39).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.023 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.015 | 0.057 |
| Bibliometrics | 0.005 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.004 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".