Management of tricuspid regurgitation in congenital heart disease

Is survival better with valve repair?

Sameh M. Said, Joseph A. Dearani, Harold M. Burkhart, Heidi M. Connolly, Benjamin W. Eidem, Paul E. Stensrud, Hartzell V Schaff

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Objective: Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. Methods: We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension. Results: TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P =.001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P =.001). Conclusions: Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.

Original languageEnglish (US)
Pages (from-to)412-417
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2014

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Tricuspid Valve Insufficiency
Tricuspid Valve
Heart Diseases
Survival
Heart Failure
Ebstein Anomaly
Sternotomy
Mortality
Ventricular Heart Septal Defects
Pulmonary Hypertension

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Management of tricuspid regurgitation in congenital heart disease : Is survival better with valve repair? / Said, Sameh M.; Dearani, Joseph A.; Burkhart, Harold M.; Connolly, Heidi M.; Eidem, Benjamin W.; Stensrud, Paul E.; Schaff, Hartzell V.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 1, 01.2014, p. 412-417.

Research output: Contribution to journalArticle

Said, Sameh M. ; Dearani, Joseph A. ; Burkhart, Harold M. ; Connolly, Heidi M. ; Eidem, Benjamin W. ; Stensrud, Paul E. ; Schaff, Hartzell V. / Management of tricuspid regurgitation in congenital heart disease : Is survival better with valve repair?. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 1. pp. 412-417.
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abstract = "Objective: Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. Methods: We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54{\%}). The most common diagnoses were conotruncal anomaly in 216 patients (39{\%}), previous ventricular septal defect closure in 83 (15{\%}), atrioventricular septal defect in 77 (14{\%}), and pulmonary atresia with an intact ventricular septum in 11 (2{\%}). Preoperative right-sided heart failure was present in 124 patients (22{\%}), and 55 patients (10{\%}) had pulmonary hypertension. Results: TV repair was performed in 442 (80{\%}) and TV replacement in 111 (20{\%}) patients. Repeat sternotomy was performed in 415 patients (75{\%}). Previous TV repair was present in 44 patients (8{\%}); of these, 17 (38.6{\%}) underwent repeat TV repair. The overall early mortality was 3.1{\%} (17 patients) and was 2.5{\%} for TV repair and 5.4{\%} for TV replacement (P =.001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97{\%}, 93{\%}, and 85{\%}, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P =.001). Conclusions: Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.",
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AU - Said, Sameh M.

AU - Dearani, Joseph A.

AU - Burkhart, Harold M.

AU - Connolly, Heidi M.

AU - Eidem, Benjamin W.

AU - Stensrud, Paul E.

AU - Schaff, Hartzell V

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N2 - Objective: Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. Methods: We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension. Results: TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P =.001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P =.001). Conclusions: Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.

AB - Objective: Tricuspid valve (TV) regurgitation in congenital heart disease includes a heterogeneous group of lesions, and few series have documented the outcomes. Methods: We reviewed the records of 553 patients with congenital heart disease who had undergone TV surgery for tricuspid regurgitation from January 1993 to December 2010. Patients with Ebstein malformation were excluded. Their mean age was 32 ± 21 years, and 300 were female (54%). The most common diagnoses were conotruncal anomaly in 216 patients (39%), previous ventricular septal defect closure in 83 (15%), atrioventricular septal defect in 77 (14%), and pulmonary atresia with an intact ventricular septum in 11 (2%). Preoperative right-sided heart failure was present in 124 patients (22%), and 55 patients (10%) had pulmonary hypertension. Results: TV repair was performed in 442 (80%) and TV replacement in 111 (20%) patients. Repeat sternotomy was performed in 415 patients (75%). Previous TV repair was present in 44 patients (8%); of these, 17 (38.6%) underwent repeat TV repair. The overall early mortality was 3.1% (17 patients) and was 2.5% for TV repair and 5.4% for TV replacement (P =.001). The mean follow-up period was 4.5 ± 4.1 years (maximum, 18). The overall survival at 1, 5, and 10 years was 97%, 93%, and 85%, respectively. Survival was better for patients with repair than with replacement. TV repair was an independent predictor of better survival (P =.001). Conclusions: Important tricuspid regurgitation can occur with a variety of congenital diagnoses. Early mortality is low and late survival is superior with tricuspid repair than with valve replacement. Surgical treatment of tricuspid regurgitation in congenital heart disease should be performed before the onset of heart failure.

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