Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes.

J Thorac Cardiovasc Surg. 2016 Feb;151(2):460-5. doi: 10.1016/j.jtcvs.2015.09.028. Epub 2015 Sep 16.

Postoperative tricuspid regurgitation after adult congenital heart surgery is associated with adverse clinical outcomes.
 

Lewis MJ1, Ginns JN2, Ye S3, Chai P4, Quaegebeur JM

Comment by Jouke Bokma

Abstract

This single-center  study evaluated outcomes after non-tricuspid-regurgitation-related surgery  in 107 CHD patients with at least moderate preoperative tricuspid regurgitation (TR). 76 patients (71%) also underwent tricuspid valve repair or replacement. De Vega annuloplasty was used for most tricuspid repairs. The composite primary outcome consisted of: death (n=10), heart transplantation (n=1) or reoperation of the tricuspid valve (n=6). The main findings of this study are: (I) moderate or greater postoperative TR is associated with the primary outcome. (II) concomitant TR repair reduces the odds for ≥moderate postoperative TR. These findings are in contrast to two recent reports (1,2), which both reported comparable TR decrease after pulmonary valve replacement with or without TV repair.  It is unclear which factors triggered TV repair/replacement in the current study as a comparison of patients with and without TV repair/replacement is lacking. Differences in the primary outcome may also be explained by a reluctance to re-operate for TR in patients with previous TV interventions and a heterogeneous study population in the present study. Moreover, the findings in this study are intriguing but more evidence is needed to determine which patients may benefit from concomitant TV interventions.

1.            Kogon B, Mori M, Alsoufi B, Kanter K, Oster M. Leaving Moderate Tricuspid Valve Regurgitation Alone at the Time of Pulmonary Valve Replacement: A Worthwhile Approach. Ann Thorac Surg. 2015;99:2117–2122; discussion 2122–2123.

2.            Cramer JW, Ginde S, Hill GD, Cohen SB, Bartz PJ, Tweddell JS, Earing MG. Tricuspid Repair at Pulmonary Valve Replacement Does Not Alter Outcomes in Tetralogy of Fallot. The Annals of Thoracic Surgery. 2015;99:899–904.