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Background: The ideal prosthesis for tricuspid valve replacement (TVR) continues to be debated. There are few published data comparing mechanical and bioprosthetic valves, and all are retrospective studies with relatively small sample sizes., Aim: This study was conducted to compare mechanical and bioprosthetic valves for TVR., Method: A literature search of six databases (PubMed, EMBASE, Ovid, ScienceDirect, JSTOR, and Wiley Blackwell's online library) was performed with the keywords "tricuspid valve disease, tricuspid valve replacement and (bioprosthetic or mechanical)". Primary outcomes were hospital mortality, long-term survival, tricuspid valve reoperation, valve failure, thrombosis, and thrombo-embolism. Risk ratio (RR) was used to compare dichotomous parameters and time-to-event outcomes. "Survival and re-interventions" were pooled using a meta-analysis of hazard ratios (HR). Publication bias was accessed using a funnel plot., Results: A total of 23 retrospective studies involving 945 mechanical and 1,332 biological tricuspid prostheses were included. The studies were published between January 2002 and September 2019. Hospital mortality (30-day mortality) did not differ between groups (RR, 0.83; 95% confidence interval [CI], 0.66-1.05; p=0.12). Long-term survival was evaluated in 15 studies, and it was not significantly different between patients with mechanical compared with those with bioprosthetic valves (pooled HR, 0.97; 95% CI, 0.61-1.54; p=0.88). Freedom from tricuspid valve reoperation was assessed in eight studies, and no difference was found between the groups (pooled HR, 1.03; 95% CI, 0.63-1.69; p=0.89). Valve failure in the 5-year postoperative period was evaluated by seven studies, and there was no statistically significant difference between the two groups (pooled RR, 1.33; 95% CI, 0.42-4.27; p=0.63)., Conclusions: The results of this meta-analysis suggest an equal risk of 30-day and late mortality, reoperation, and 5-year valve failure in patients with mechanical versus biological TVR. The choice of the prosthesis in the tricuspid position should depend mainly on the patient's risk factors and no superiority of one prosthesis over the other in this position., (Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Surgical repair of concomitant functional moderate tricuspid valve (TV) regurgitation at the time of mitral valve (MV) surgery remains controversial., Aim: The objective of this study was to evaluate the outcomes of concomitant repair of functional moderate tricuspid regurgitation (TR) during MV surgery for rheumatic valve disease., Method: From 1998 to 2016, 1,240 patients had rheumatic MV disease associated with moderate functional TR: 974 patients had MV surgery and concomitant TV repair (group 1) and 266 patients had MV surgery alone (group 2). Study endpoints were operative outcomes, rehospitalisation for congestive heart failure (CHF), and TV reintervention. Propensity score matching identified 192 well-matched pairs for outcomes comparison., Results: Patients who had concomitant TV repair were younger (p=0.02) and there were fewer diabetics (p=0.015). In matched patients, low cardiac output was significantly higher in group 2 (p=0.044) and there was no difference in ventilation time, intensive care unit stay, cardiopulmonary bypass, and ischaemic times (p=0.480, p=0.797, p=0.232, and p=0.550, respectively) between groups. Patients in group 2 required more TV reintervention (1 vs 35 in group 1 and 2, respectively; p=0.004) and rehospitalisation for CHF (5 vs 40 in group 1 and 2, respectively; p<0.001)., Conclusions: Concomitant TV repair for moderate TR in patients undergoing rheumatic MV surgery was not associated with increased operative risk. Postoperative low cardiac output syndrome and the risk of late TV reinterventions and rehospitalisation for CHF were lower with TV repair. Concomitant repair of the moderate TV regurgitation maybe beneficial for patients undergoing rheumatic MV surgery., (Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Background: Cellular injury is not avoidable with current cardioplegic solutions. The effect of adenosine on reducing cardiac injury post-surgery is controversial. The objective of the current study is to evaluate the effect of fast cardioplegic arrest induced by adenosine on high sensitive cardiac troponin I after heart valve surgery., Methods: Forty-five (45) patients with rheumatic heart diseases underwent heart valve surgery using conventional approach through median sternotomy. They were classified into two groups, group I (n=21) patients received 0.25mg/kg adenosine into the aortic root just after aortic cross-clamping and before infusion of the cold hyperkalaemic crystalloid cardioplegia via antegrade route and group II (n=24) who received cold crystalloid hyperkalaemic cardioplegia without adenosine. Cardiac troponin I was measured preoperatively and on postoperative days 0, 3 and 7., Results: There was no significant difference between both groups in the demographic, preoperative and operative data. Adenosine significantly reduced arrest time. Postoperative high sensitive cardiac troponin I increased significantly in both groups compared to the preoperative levels and the rise continued till postoperative day 3. Troponin levels were significantly lower in the adenosine group compared to the control at all measurements. The clinical outcomes were non-significant different between groups., Conclusions: Using adenosine in inducing fast cardioplegic arrest in heart valve surgery after aortic cross clamp and prior to infusion of the cold cardioplegia had significantly decreased postoperative cardiac troponin levels which was used as a proxy for cellular injury compared to the control group., (Copyright © 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)