Long-Term Outcomes of Tricuspid Valve Surgery in Patients With Congenitally Corrected Transposition of the Great Arteries

Abstract

Background: Valvuloplasty is generally considered unsuccessful in patients with congenitally corrected transposition of the great arteries. Optimal timing of tricuspid valve surgery in these patients is crucial.

Methods and results: We retrospectively reviewed 57 patients with congenitally corrected transposition of the great arteries undergoing tricuspid valve surgery at our institution. Eleven patients had tricuspid valve plasty and 46 had tricuspid valve replacement. Mean duration of follow-up was 7.4±5.5 years in the group of tricuspid valve plasty and 5.6±3.6 years in the group of tricuspid valve replacement, respectively (P=0.33). For the total of 57 patients, estimates of 1-, 5-, and 10-year survival or freedom from transplantation were 96.4%, 91.6%, and 75.6%, respectively. Late right ventricular ejection fraction of most patients (90%) remained preserved (≥40%) during the follow-up. In a highly selected group of tricuspid valve plasty recipients, although long-term survival and right ventricular function were similar compared with tricuspid valve replacement, recurrent tricuspid regurgitation was observed in 60% of these patients. Multivariate Cox regression analysis identified preoperative right ventricular end-diastolic dimension (1-cm increment; harzard ratio, 3.22; P=0.02) as an independent predictor of postoperative mortality or need for transplantation. Patients undergoing surgery with a right ventricular end-diastolic dimension ≥60 mm had a significant lower survival rate compared with those with a right ventricular end-diastolic dimension <60 mm (P=0.003).

Conclusions: Tricuspid valve surgery in patients with congenitally corrected transposition of the great arteries could yield satisfactory long-term outcomes. Recurrent tricuspid regurgitation was frequently observed in tricuspid valve plasty recipients. Preoperative right ventricular end-diastolic dimension was a risk factor for late mortality and surgery should be performed before cardiac enlargement and dysfunction for best outcomes.

Keywords: congenital heart disease; congenitally corrected transposition of the great arteries; systemic right ventricle; tricuspid valve plasty; tricuspid valve replacement.