Poor Late Outcomes After Tricuspid Valve Repair in a Single Ventricle: Experience of 103 Patients

Background. Outcomes of tricuspid valve repair in single-ventricle palliation are poor. We sought to identify the impact of repair technique and primary mechanisms of regurgitation on outcomes after surgery. Methods. A retrospective review of medical records across 4 centers undertaking single-ventricle palliation in Australia and New Zealand was performed. Patients with a dominant right functional single ventricle undergoing tricuspid valve repair between January 1991 and March 2019 were identified. Results. One hundred three patients met inclusion criteria, with a median follow-up duration of 6.7 years (interquartile range, 1.5-12.4). Mechanism of regurgitation was structural in 30 patients, functional in 28 patients, and a combination of both in 24 patients (21 missing). Surgical repair technique consisted of annuloplasty in 42 patients, leaflet and/or subvalvular repair in 12 patients, and a combination of both in 44 patients (5 missing). Thirty-four patients died, and 5 underwent heart transplantation. Fifty-two patients experienced valve repair failure (22 re-repairs, 7 replacements, and 23 recurrent regurgitation). Of 17 patients with early valve repair failure (within 30 days of repair), 14 died. Freedom from death or transplant at 5 years after repair for patients with a successful repair was 79% (95% confidence interval, 70%-90%) compared with 15% (95% confidence interval, 6%-37%) for those with a failed repair (P < .01; hazard ratio, 8.95; 95% confidence interval, 4%-18%). Conclusions. Tricuspid valve repair failure occurs frequently in patients with a single ventricle and is associated with a significant risk of mortality. The persistence of moderate regurgitation after repair mandates reoperation. (C) 2021 by The Society of Thoracic Surgeons

Automated summary

Tricuspid valve repair failure is common in single-ventricle patients and is associated with a significant risk of mortality, requiring reoperation for persistent moderate regurgitation.