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

Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot

“…In contrast, Cramer and colleagues 5 reported that TV repair at the time of PVR may not have a clinical benefit, with a similar TR grade at 6 months postoperatively with or without TV repair (in the absence of a clear tricuspid valve abnormality). In this study, however, patients who underwent PVR alone had a slightly lower grade of TR (2.2 vs 2.7, P ¼ .008) and a slightly smaller tricuspid valve annulus diameter, compared with patients who underwent concomitant TV repair.…”

“…[2][3][4] Indeed, only scarce data on the surgical management of TR at the time of PVR have been published so far, with controversial results. [5][6][7][8] In these adult patients with repaired TOF who underwent PVR, we sought to (1) determine factors that predispose to the development of significant preoperative TR and (2) evaluate the efficacy of a concomitant tricuspid valve (TV) repair at the time of PVR.…”

“…In our series, the incidence of significant TR was 39.5%, which is comparable with previously reported incidences, varying from 19% to 58%. [3][4][5] A recent study highlighted the fact that early reduction (in the first 2-3 postoperative years after PVR) in RV size, progressively deteriorates at 7 to Congenital: Tetralogy of Fallot 10 years post-PVR, leading to reverse remodeling and worsened RV function. 13 This secondary deterioration has been inherent mostly to a subsequent progressive bioprosthetic pulmonary valve dysfunction, but some has been attributed to a TR.…”

Heart Failure in Adult Congenital Heart Disease

“…Whether to proceed with concomitant tricuspid valve repair at the time of PVR remains controversial. 45,46 Systemic RV failure is a major cause of morbidity among adults with congenitally corrected transposition of the great arteries and is the cause of death in more than 50% of patients. 47 Systemic RV failure and severe systemic TR often coexist, even in the absence of other associated lesions such as an Ebstein-like malformation of the tricuspid valve.…”

History Repeats Itself: Concomitant Tricuspid Regurgitation

“…Previous reports showed that even though only 2% of patients experienced significant TR immediately after operation, about 16% of patients experienced significant TR 8 years after operation [3]. Considering TOF patients who require reoperation, Kogon and colleagues [1] and Cramer and colleagues [4] showed that a total of only 5 patients with severe TR could avoid a tricuspid operation. As is the case with mitral disease, the sample size and follow-up duration were too small to enable determination of the priority of conservative therapy at this moment.…”