Faculty Collaboration Database

Tricuspid repair at pulmonary valve replacement does not alter outcomes in tetralogy of Fallot. Ann Thorac Surg 2015 Mar;99(3):899-904

Date

01/19/2015

Pubmed ID

25596869

DOI

10.1016/j.athoracsur.2014.09.086

Scopus ID

2-s2.0-84924625832 (requires institutional sign-in at Scopus site)   36 Citations

Abstract

BACKGROUND: Chronic pulmonary regurgitation after tetralogy of Fallot repair often leads to progressive right ventricle dilation, dysfunction, and frequently, pulmonary valve replacement. For those with significant tricuspid regurgitation at the time of pulmonary valve replacement, it is unknown whether concomitant tricuspid valve repair improves postoperative outcomes.

METHODS: This is a retrospective review of patients after tetralogy of Fallot repair who underwent pulmonary valve replacement between 1999 and 2012. Preoperative and postoperative echocardiograms were assessed for tricuspid regurgitation (vena contracta) and right ventricular size and function (Tomtec software).

RESULTS: Sixty-two patients underwent pulmonary valve replacement. Thirty-six (58%) had greater than or equal to moderate tricuspid regurgitation on preoperative echocardiogram. Significant predictors were not identified. Of the 36, 18 (50%) underwent concomitant tricuspid valve repair at the time of pulmonary valve replacement. After surgery, there was a significant reduction in the degree of tricuspid regurgitation (p < 0.001) and measures of right ventricular size (p < 0.05) in both cohorts. Between surgical groups, there was no statistical difference in the grade of tricuspid regurgitation (p = 0.47) or measures of right ventricular size (p > 0.4) at 6-month follow-up.

CONCLUSIONS: Tricuspid regurgitation is a common finding in repaired tetralogy of Fallot, although risk factors for its development remain unclear. After pulmonary valve replacement with or without tricuspid valve repair there is significant improvement in the degree of tricuspid regurgitation and right ventricular size. Finally, 6 months after pulmonary valve replacement there were no statistical differences between those patients undergoing concomitant tricuspid valve repair and those undergoing pulmonary valve replacements alone.

Author List

Cramer JW, Ginde S, Hill GD, Cohen SB, Bartz PJ, Tweddell JS, Earing MG

Authors

Peter J. Bartz MD Chief, Professor in the Pediatrics department at Medical College of Wisconsin
Scott B. Cohen MD Professor in the Medicine department at Medical College of Wisconsin
Salil Ginde MD, MPH Associate Professor in the Pediatrics department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Aged
Cardiac Surgical Procedures
Heart Valve Prosthesis Implantation
Humans
Middle Aged
Postoperative Complications
Pulmonary Valve
Pulmonary Valve Insufficiency
Retrospective Studies
Risk Assessment
Tetralogy of Fallot
Treatment Outcome
Tricuspid Valve Insufficiency
Young Adult