Effects of tricuspid valve surgery on tricuspid regurgitation in patients with hypoplastic left heart syndrome: a non-randomized series comparing surgical and non-surgical cases

Abstract

The survival of HLHS patients who develop moderate or greater TR around the time of the first palliative surgery is worse than that of HLHS patients who develop moderate or greater TR at a later time. In this study, TVS for early TR improved survival and decreased right ventricular dimensions during the 4.9-year follow-up period.

Mechanisms of tricuspid regurgitation in patients with hypoplastic left heart syndrome undergoing tricuspid valvuloplasty

“…Significant TR at birth is a well-known risk factor for early mortality after stage I palliation 12 and is a common late finding, with approximately 25% of stage I survivors undergoing TV intervention within 10 years. 8 In patients with HLHS, the TV functions as the systemic atrioventricular valve; therefore, anatomic abnormalities of the TV will have dramatic effects on morbidity and mortality.…”

“…The mechanism of TV regurgitation in HLHS is complex, multifactorial, and can be anatomic or functional. 11,12 Furthermore, the actual contributing factors toward TR have not been consistently agreed on. 11 When considering the mechanisms contributing to TR in patients with HLHS, one must consider the annulus, leaflets, chordal structures, and ventricle.…”

“…It has been consistently reported in published studies that patients showing significant TR before the Norwood procedure are at high risk of morbidity and mortality and thus will not complete staged palliation. 12 Because the main goal of our study was to evaluate the underlying mechanisms of TR through follow-up of patients completing staged palliation and because TV plasty was not routinely performed during the early period of our study, we excluded patients who had undergone TV repair at stage I. The institutional review board approved the present study.…”

“…9,10 Several reports have suggested that TV repair decreases the severity of TR and could improve the outcomes in patients with HLHS. [11][12][13][14] De Vega type annuloplasty, selective annuloplasty, cleft closure, chordal shortening, posterior leaflet obliteration, and commissure closure have been used to repair the TV in this population; however, no standard surgical approach exists. Recent advances in echocardiography and the understanding of the mechanisms of RV and TV function in the systemic circulation have made it possible to systematically evaluate the TV preoperatively with the aim of tailoring the surgical technique to specific anatomic abnormalities.…”

Outcome of Tricuspid Valve Plasty in Norwood Stage I Operation

“…33 Sugiura et al reported their experience of bilateral PA banding (n=9) for early significant TR in HLHS, and of their patients 3 died before Norwood-Glenn operation. 34 We think bilateral PA banding is beneficial for patients with pulmonary overflow, but not helpful for other TR mechanisms such as coarctation, TV abnormality, or coronary ischemia from a small ascending aorta. Because of the limited information, how to select the most appropriate approach for specific patients requires more studies.…”