Tricuspid valve surgery in adults with congenital heart disease: Indications, techniques and outcomes

Abstract

BackgroundTricuspid valve (TV) pathology can occur in a diverse range of patients with adult congenital heart disease (ACHD). Data is lacking to guide indications and timing for surgical TV intervention and few series have documented the outcomes of TV surgery in this heterogenous cohort. MethodsWe reviewed the records of 36 patients with congenital heart disease and biventricular circulations who had undergone TV surgery. Fourteen were men (38%) and mean age at the time of TV surgery was 36 ± 13years. 19 had Ebstein's anomaly (53%) and 17 had alternative diagnoses (47%), including TV disease associated with pulmonary stenosis (20%), Tetralogy of Fallot (11%), atrioventricular septal defects (11%) or TV dysplasia (5%). ResultsThe most common indication for surgery was severe tricuspid regurgitation (TR) and right-sided heart failure. The TV was repaired in 22 (61%) and replaced in 14 (39%). There was no peri-operative or 30-day mortality, and only one patient died during medium-term follow-up. At last follow up (9.8±8years from operation), 25 (71%) patients were functional New York Heart Association (NYHA) Class I. Four patients required re-operation at a mean age of 48 ± 11years and 9.2±7years after their initial TV surgery. In patients who underwent a single TV surgery, 83% had trivial or mild TR at 8.1 ± 7.5years from date of surgery, and no patients had more than mild obstruction to TV inflow. ConclusionIrrespective of the underlying pathology for TV disease in patients with ACHD, surgical TV intervention is associated with very low early mortality and good medium to long-term outcomes, when patients are cared for at a specialised ACHD centre.