Tricuspid Repair at Pulmonary Valve Replacement Does Not Alter Outcomes in Tetralogy of Fallot

Ann Thorac Surg. 2015 Jan 14. pii: S0003-4975(14)01981-X. doi: 10.1016/j.athoracsur.2014.09.086. [Epub ahead of print]

Tricuspid Repair at Pulmonary Valve Replacement Does Not Alter Outcomes in Tetralogy of Fallot.

Cramer JW1Ginde S2Hill GD1Cohen SB2Bartz PJ2Tweddell JS3Earing MG4.

Comment: In this article Cramer et al. compared the outcomes of pulmonary valve replacement with or without concomitant tricuspid valve repair. Tricuspid regurgitation often develops due to right ventricular volume overload due to residual pulmonary regurgitation in TOF patients. This study focused on the question whether correction of only pulmonary regurgitation is sufficient in these patients or whether concomitant TV repair should be performed.

The present study included 36 patients who had moderate or severe preoperative tricuspid regurgitation. In both patients with (n=18) or without (n=18) concomitant TV surgery the degree of tricuspid regurgitation markedly decreased. There was no difference between both groups in postoperative RV size or TR severity (PS=NS for both). The authors conclude there is no beneficial effect of TV surgery. However, the main limitation of this study is it’s retrospective design which led to substantial baseline differences between both groups. The authors corrected for this with a small subgroup analysis of patients with severe TR only. Further investigation may focus on clinical and long-term outcomes of PVR in patients with moderate or severe TR.