Author + information
- Masamichi Ono,
- Melchior Burri,
- Julie Cleuziou,
- Jelena Pabst von Ohain,
- Elisabeth Beran,
- Martina Strbad,
- Alfred Hager,
- Christian Schreiber and
- Rüdiger Lange
Background: Tricuspid regurgitation (TR) remains a risk for staged palliation in patients with a systemic right ventricle. This study was performed to determine the morphology of the tricuspid valve (TV) in these patients leading to TR and to describe surgical management.
Methods: Among 460 patients who underwent a total cavopulmonary connection between 1994 and 2015, 155 patients with a systemic right ventricle had a TV as a single atrioventricular valve. Diagnoses included HLHS in 105 patients, mitral atresia (MA) and DORV in 17, MA and TGA in 6 and single TV with a single ventricle in 27. In patients who required TV surgery, timing of surgery, pathophysiology of TR, and outcomes were evaluated.
Results: Forty patients (26%) needed TV surgery. Timing of initial TV surgery was before or at stage II in 11 patients (28%), between stage II and III in 3 (7%) and at stage III in 26 (65%). TR was due to one or more of the following pathologies: dysplastic leaflet in 26 patients (65%), leaflet prolapse in 20 (50%), restrictive leaflet in 12 (30%), chordal anomaly in 8 (20%), and cleft in 7 (18%). For leaflet prolapse and dysplasia, the anterior leaflet was most commonly affected (62%). Regurgitation was most commonly detected at the anteroseptal (AS) commissure in 22 patients (55%). TV repair was performed in 36 patients (90%) using leaflet reconstruction in 26 (65%), commissuroplasty in 24 (60%), complete/partial annuloplasty in 17 (43%), and cleft closure in 7 (18%). TV replacement with a mechanical valve was required in 4 patients (10%). A second TV surgery was necessary in 12 patients (30%) and a third in 3 (8%). Freedom from reoperation on the TV was 65.5% at 5 years. Finally, 5 of 36 patients (14%) who had undergone initial TV repair needed TV replacement at the second (4) or the third (1) TV surgery, while 31 patients (86%) kept their own TV.
Conclusions: TR is a common problem in patients with univentricular heart and a systemic right ventricle. Most often it is the result of dysplastic, prolapsing or restrictive leaflets and emanates from the AS commissure. Surgical repair is challenging and may require more than one attempt. Severe regurgitation may require earlier intervention but is most commonly performed at stage III.
Moderated Poster Contributions
Congenital Heart Disease and Pulmonary Hypertension Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 12:45 p.m.-12:55 p.m.
Session Title: Finding Out What Works in Pediatric and Congenital Heart Disease
Abstract Category: 11. Congenital Heart Disease: Therapy
Presentation Number: 1312M-05
- 2017 American College of Cardiology Foundation