Management of tricuspid regurgitation in congenital heart disease: is survival better with valve repair?

J Thorac Cardiovasc Surg. 2014 Jan;147(1):412-7. doi: 10.1016/j.jtcvs.2013.08.034. Epub 2013 Sep 29.

Abstract

Objective: Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes.

Methods: We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension.

Results: TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P = .001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P = .001).

Conclusions: Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.

Keywords: 20; 35; AVSD; EM; Ebstein malformation; ICD; TR; TV; VSD; atrioventricular septal defect; implantable cardiac defibrillator; tricuspid regurgitation; tricuspid valve; ventricular septal defect.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Child
  • Female
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / diagnosis
  • Heart Defects, Congenital / mortality
  • Heart Defects, Congenital / surgery*
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis Implantation* / mortality
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Proportional Hazards Models
  • Reconstructive Surgical Procedures* / adverse effects
  • Reconstructive Surgical Procedures* / mortality
  • Risk Factors
  • Time Factors
  • Treatment Outcome
  • Tricuspid Valve Insufficiency / diagnosis
  • Tricuspid Valve Insufficiency / etiology
  • Tricuspid Valve Insufficiency / mortality
  • Tricuspid Valve Insufficiency / surgery*
  • Young Adult