Studying the Outcomes in Patients with Tricuspid Regurgitation Treated with Valve Repair or Valve Replacement: Interpreting the Survival Pattern on The Long Term by Application of Artificial Intelligence Methods

Abstract

Background: The reconstruction of individual patient data from published Kaplan-Meier survival curves is a new technique (often denoted as the IPDfromKM method) for studying efficacy in cases where multiple trials are available, and the endpoint is long-term mortality. In patients with tricuspid regurgitation, both valve repair and valve replacement have been proposed to improve prognosis; 6 controlled clinical trials (CTs) have been conducted to compare the two therapeutic options mentioned above. The objective of our analysis was to study these six trials through the application of the IPDfromKM method. Methods: In the present report, we applied the IPDfromKM method to carry out a pooled analysis of these 6 CTs to investigate the effectiveness of valve repair vs valve replacement and to assess the between-study heterogeneity from this clinical material. After reconstructing individual patient data from these 6 trials, patients treated with valve repair were pooled together and their Kaplan-Meier curve was generated. Likewise, patients treated with valve replacement were pooled together and their Kaplan-Meier curve was generated. Finally, these two curves were compared by standard survival statistics. The hazard ratio (HR) was determined; death from any cause was the endpoint. Results: These 6 CTs included a total of 552 patients; in each of these CTs, the patient group treated with valve repair was compared with another group treated with valve replacement. Our statistical results showed a significantly better survival for valve repair compared with valve replacement (HR, 0.6098; 95% confidence intervals (CI), 0.445 to 0.835; p = 0.002). Heterogeneity was found to be significant in the 6 patient arms undergoing replacement, but not in those undergoing valve repair. In valve replacement, the classification of patients in class III or IV of New York Heart Association (NYHA) was the main negative prognostic factor. Conclusions: Our analysis confirmed the methodological advantages of the IPDfromKM method in the indirect comparative analysis of multiple trials. These advantages include appropriate analysis of censored patients, original assessment of heterogeneity, and graphical presentation of the results, wherein individual patients retain an important role.