Results for tricuspid valve surgery in adults with congenital heart disease other than Ebstein’s anomaly†

Abstract

OBJECTIVES: Tricuspid valve (TV) surgery in the adult with congenital heart disease (ACHD) is a frequently performed procedure. The aim of this study was to analyse postoperative and medium-term outcomes. METHODS: We conducted a single-centre retrospective study of patients with ACHD who underwent TV surgery (January 2000–December 2016); patients with Ebstein’s anomalies were excluded. Operative and clinical records were reviewed. Outcomes considered were survival, grade of insufficiency/stenosis and TV reoperation at follow-up. RESULTS: A total of 128 patients with ACHD had TV surgery for functional regurgitation (n = 95), dysplasia (n = 23) and systemic TV (n = 10). Median age was 40.8 years [interquartile range (IQR) 25.3]; 55.5% were men. Preoperative regurgitation was classified as mild (n = 8), moderate (n = 47) and severe (n = 70). The TV was repaired in 109 as follows: ring annuloplasty (n = 43), de Vega annuloplasty (n = 29), Wooler annuloplasty (n = 13), commissural plasty (n = 9), Kay annuloplasty (n = 7) and others (n = 8). The TV was replaced in 19 patients with biological (n = 10) and mechanical (n = 9) prostheses. The median hospital stay was 12 days (IQR 10). The overall mortality rate was 8.6% (n = 11): 2 hospital deaths (1.6%) and 9 late deaths. Survival was 93% [95% confidence interval (CI) 85–97%] at 5 years and 83% (95% CI 70–91%) at 10 years. The median follow-up period was 4.95 years (IQR 7.7) with 1 TV reoperation. Echocardiographic assessment showed ≥moderate regurgitation in 34 (34.3%) patients. Suture plasty had a significantly higher incidence of TV regurgitation ≥moderate compared to ring annuloplasty (48.9% vs 26.3%; P = 0.033). CONCLUSIONS: TV surgery in the ACHD is frequently associated with other main procedures. Stabilizing the TV annulus with a prosthetic ring guarantees lower recurrence of moderate to severe regurgitation compared to suture plasty repair.

Outcomes and risk analysis after tricuspid valve surgery for non-Ebstein 2-ventricle congenital tricuspid valve diseases

“…Similar studies looking specifically at patients with adult congenital heart disease undergoing TV intervention reported high rates of TR recurrence following TV intervention. Indeed, Lo Rito and colleagues 22 analyzed 128 patients with adult congenital heart disease undergoing TV surgery. Of these, 74% had functional TR, 18% dysplastic valve and 8% systemic TV.…”

“…These procedures included annuloplasty in 50.6% (n ¼ 43), commissuroplasty in 12.9% (n ¼ 11), subvalvular intervention in 10.6% (n ¼ 9), and leaflet intervention in 5.9% (n ¼ 5). TV replacement was performed in 22 remainder undergoing mitral valve repair. Two patients did not undergo concomitant mitral valve intervention, both of whom had undergone prior heart transplantation and presented with severe TR and moderate MR and both underwent a TV replacement only.…”

Tricuspid Valve Intervention at the Time of Pulmonary Valve Replacement in Adults With Congenital Heart Disease: A Systematic Review and Meta‐Analysis

“…Of the 30 patients with available echocardiographic data, all 5 with moderate or greater TR underwent TV repair. 24 In an analysis of 109 TV repairs and 19 replacements in 128 patients with ACHD other than Ebstein anomaly, Lo Rito et al 25 found that those who underwent suture annuloplasty had a higher rate of moderate or greater TR at latest follow‐up (4.95 years; 7.7 interquartile range) compared with those with ring annuloplasty. The only patient who required TV reintervention had an initial biological valve replacement.…”

“…Importantly, both studies describe a high incidence of atrial arrhythmias following TVI, regardless of surgical approach. 25 , 26 …”

Every day mitral valve reconstruction: What has changed over the last 15 years?

“…resection maneuvers to predominant use of artificial chordae [12][13][14][15][16][17][18]. In the early years the classical recommendations such as reshaping of the posterior leaflet by resection or plication maneuvers as well as reshaping of the annulus by appropriate rings were mostly followed but measures such as Wooler plasty, Paneth plasty, or Alfieri Stitch were still performed [19,20]. However, they did not exhibit such robust evidence in the literature regarding a beneficial effect on long-term patency as posterior leaflet correction and/or artificial chordae.…”