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

Mauro Lo Rito, Maria Grandinetti, Giulia Muzio, Alessandro Varrica, Alessandro Frigiola, Angelo Micheletti, Massimo Chessa, Alessandro Giamberti

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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.

Original languageEnglish
Pages (from-to)706-713
Number of pages8
JournalEuropean Journal of Cardio-thoracic Surgery
Volume56
Issue number4
DOIs
Publication statusPublished - Oct 1 2019

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Keywords

  • Adult with congenital heart disease
  • Atrial septal defect
  • Congenital heart disease
  • De Vega
  • Grown up congenital heart disease
  • Heart failure
  • Long-term outcome
  • Outcomes
  • Prosthetic ring
  • Surgery
  • Tetralogy of Fallot
  • Tricuspid valve
  • Valve repair

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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