C. Tan1, A. Zhu1, L. Huang1, B. Robinson1, P. Bannon1 1Royal Prince Alfred Hospital, Sydney, NSW, Australia
Introduction:
Beating heart (BH) technique offers an advantage over arrested heart (AH) with no ischaemic time and low risk of embolization in tricuspid valve surgery (TVS). However, there are paucity of evidence available that compares both techniques. Therefore, we performed a meta-analysis comparing BH and AH techniques in isolated TVS.
Methods:
A systematic review was performed across 8 electronic databases from inception to May 2023. Inclusion criteria were studies that reported outcomes of both BH and AH isolated TVS. Studies were identified and data extracted by two independent reviewers. Data were extracted and pooled using random-effects models and Review Manager 5.4 software.
Results:
From 903 abstracts screened, 7 studies were included, where 7306 patients had isolated TVS. Where 53% had BH and 47% had AH surgery. The pre-operative EuroScoreII was higher in the BH than the AH group (9.4 ± 8.7 vs 6.1 ± 4.9) and 49% of patients in the BH group had atrial fibrillation compared to 39% in the AH group. BH group had higher 30-day mortality rate than AH group (9.6% vs 6.5%). But BH surgery had higher rates of freedom from mortality (p=0.0002); lower rates of post-operative stroke (p=0.04); lower rate of re-operation for bleeding (p= 0.003) but higher rate of post-operative pacemaker implantation (p=0.002).
Conclusions:
BH strategy offers long-term superiority to AH in patients undergoing isolated TVS in terms of overall survival, post-operative stroke rates, reoperation for bleeding rates and overall hospital length of stay. We propose earlier timing and beating heart surgery for isolated TVS.
Figure 1: Forest Plot Comparing Arrested Heart to Beating Heart Surgery in Tricuspid Valve Surgery in Preventing Death