Outcome of Tricuspid Valve Plasty in Norwood Stage I Operation

Abstract

Background: Significant tricuspid valve regurgitation (TR) is considered a poor prognosis factor for patients with hypoplastic left heart syndrome (HLHS). Performing a tricuspid valve plasty (TVP) during Norwood Stage I palliation (S1P) has rarely been reported. We report mid-term results of performing TVP during Norwood S1P. Methods and Results:Between December 2004 and July 2013, 48 patients with HLHS or variants underwent Norwood S1P and of them 11 (23%) with TR of a moderate degree or above underwent TVP. The estimated 1-and 5-year survival rates for Norwood S1P were 61% and 54%, respectively. Among the 11 patients with TVP, there were 2 early deaths. Nine patients had a Stage II operation and 3 of them died late. Four patients completed a Fontan operation, and 2 were waiting. Using Cox regression analysis, lower body weight, presence of intact atrial septum, and preoperative cardiopulmonary resuscitation were factors associated with increased risk for death. Patients with significant TR and undergoing TVP during Norwood S1P had a similar survival curve to those without significant TR. Conclusions:Our results for TVP performed during Norwood S1P were encouraging. They suggested that aggressive TVP is warranted in Norwood S1P when primary heart transplantation is not available. Further study is required to determine if the strategy does improve the results for patients with HLHS and TR initially. (Circ J 2016; 80: 1362 -1370

Tricuspid valve repair can restore the prognosis of patients with hypoplastic left heart syndrome and tricuspid valve regurgitation: a meta-analysis

“…Pooled transplant-free survival of patients undergoing TV repair did not differ from the one of 323 patients with HLHS without TVR used as controls [13,15,16,35] (p = 0.59, Fig. 5).…”

“…5). When selecting those patients with TVR requiring surgery (n = 84) only from studies reporting controls [13,15,16,35], transplant-free survival between the two groups was still comparable (p = 0.88, Supplemental Fig. 4), with a pooled HR of mortality of 1.12 (95% CI = 0.77-1.62, p = 0.568).…”

“…Five manuscripts [13,15,16,22,35] (for a total of 104 patients) reported Kaplan-Meyer curves with a follow-up starting from the time of Norwood operation, which allowed for the reconstruction of transplant-free survival data. The meta-analysis conducted on the identi ed studies estimated a transplant-free survival at 1, 2, 5, and 10 years of follow-up of 75.5% [95% CI = 67.6-84.3%], 69.4% [95% CI = 60.9-79%], 63.6% [95% CI = 54.6-73.9%], and 61.9% [95% CI = 52.7-72.6%], respectively (Fig.…”

Atrioventricular valve regurgitation in patients undergoing total cavopulmonary connection: Impact of valve morphology and underlying mechanisms on survival and reintervention

“…Thus, preventing annular dilatation is critical to preserving ventricular and AVV function. Chronic volume overload-related ventricular dysfunction may not be reversible after AVV surgery, and AVV regurgitation is unlikely to respond to volume-unloading surgery alone [30][31][32] ; therefore, to prevent further annular dilatation and preserve or improve ventricular function, it might be preferable to widen the indications for annuloplasty at stage II (BCPS), or even at stage I (Norwood), 33 in patients with severe annular dilatation and moderate AVV regurgitation.…”

“…Several reports suggested the benefit of early AVV intervention in patients with single ventricles. 6,33,34 Early AVV repair before TCPC could prevent the breakdown of systemic ventricular function at the time of Fontan completion as Imai and colleagues 3 reported. We compared the postoperative outcomes of patients who received AVV repair at the time of TCPC and before TCPC.…”