Tricuspid valve replacement (TVR) is required when repair is not feasible, and it continues to be a relatively high-risk procedure owing to the complex medical and/or surgical profile of patients. The choice between mechanical and biological prostheses for TVR remains a subject of debate owing to their distinct advantages and disadvantages. This study aimed to analyse and compare the clinical outcomes of these two types of prostheses in the tricuspid position. PubMed, EMBASE, Web of Science, and the COCHRANE library were searched from 1995 to April 2023 for studies comparing clinical outcomes of mechanical versus biological valves in the tricuspid position. Data on 30-day mortality, reoperations, 5-year valve failure rates, thrombotic/thromboembolic events, and long-term survival were extracted, pooled, and analysed. Forest plots were generated using a random-effects model. From an initial pool of 4716 citations, 37 studies meeting our inclusion criteria were assessed, collectively encompassing 8316 prostheses (3796 mechanical, 4520 bioprostheses). Our analysis revealed that mechanical valves exhibited a non-significant trend towards diminished 30-day mortality (RR = 0.85, 95% CI = 0.69–1.06). A distinct disparity emerged in valve durability, with mechanical valves demonstrating a significantly increased risk of 5-year valve failure (RR = 2.21, 95% CI = 1.38–3.56). Strikingly, mechanical valves displayed a substantial six-fold elevated risk of thrombotic events (RR = 6.29, 95% CI = 3.98–9.92). In contrast, the long-term survival and reoperation rates demonstrated no statistically significant differences between the two valve types. This systematic review and meta-analysis provides insights into the selection of mechanical and bioprosthetic valves for TVR. These findings highlight the potential advantages and disadvantages of mechanical and bioprosthetic valves in terms of early mortality, valve durability, and thrombotic risk. Our analysis provides clinicians with evidence-based guidance for optimizing outcomes in TVR, offering a foundation for informed decision-making in this intricate surgical landscape. Despite these insights, clinicians must overcome the limitations of retrospective studies, evolving healthcare, and anticoagulant disparities to ensure careful consideration in tricuspid valve replacement decisions.

Objectives: Acute aortic dissection (AAD) is a critical vascular emergency with distinct outcomes for type A and type B patients. Despite recent improvements in surgical outcomes and lower mortality, the long-term impact of the false lumen status on future patients’ outcomes remains uncertain. This systematic review and meta-analysis aimed to comprehensively evaluate the long-term prognostic implications of false lumen status in patients presenting with AAD. Methods: A meticulous literature search was conducted in PubMed, Embase, Scopus, Web of Science, and Cochrane Central, covering the period from 1995 to April 2023, in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria encompassed studies on AAD reporting the prognostic impact of false lumen status, with a follow-up duration exceeding 1 year. Two independent researchers conducted data extraction and quality assessment. Study quality was assessed using the Newcastle–Ottawa scale. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software. Random effects model of data synthesis was chosen with effect size measure selected as hazard ratio (HR), and heterogeneity was assessed with the Higgins I ² statistic. Results: The review encompassed 20 studies involving 4247 patients with AAD. Patent false lumen was significantly associated with increased long-term mortality (HR = 1.73; 95% confidence interval [CI], 1.25–2.39; P = 0.001; I ² = 2.6%) and aortic events (HR = 2.80; 95% CI, 1.71–4.75; P < 0.001; I ² = 55.6%), with stronger associations observed in Asian populations compared with non-Asian cohorts. The analysis revealed a significant correlation between patent false lumen and heightened risks of both long-term mortality and aortic events in both types A and B AAD patients. Partially thrombosed false lumens showed an association with increased long-term mortality, particularly in type A aortic dissection cases, while completely thrombosed false lumens did not exhibit significant associations with adverse outcomes. Subgroup analyses showed a higher risk of long-term mortality in type A compared with type B, particularly among Asian populations with smaller sample sizes and shorter follow-up durations. Conclusion: The present systematic review provides critical insights into the relationship between false lumen status and long-term outcomes in AAD. This will help in risk assessment and tailoring treatment for these patients. Strict long-term follow-up is warranted in patients with patent false lumen, and selective late intervention may be considered in high-risk individuals based on clinical judgment.