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. 2022 Jun 25:11:363-372.
doi: 10.1016/j.xjon.2022.06.015. eCollection 2022 Sep.

Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experience

Mehar Hoda  1 , Robert Douglas Benjamin Jaquiss  2 , Lorraine James  3 , Poonam Punjwani Thankavel  4
Affiliations

Mechanical tricuspid valve replacement in hypoplastic left heart syndrome: An institutional experience

Mehar Hoda et al. JTCVS Open. .

Abstract

Objective: Atrioventricular valvar regurgitation in patients with single ventricles is associated with worse outcomes. Valve repair or replacement has been undertaken in an attempt to reduce mortality and morbidity. Current data on valve replacement in single ventricle patients are limited and derived from heterogenous populations. We describe our experience with repair and replacement of the tricuspid valve in children undergoing single ventricle palliation for hypoplastic left heart syndrome.

Methods: We included 27 patients with hypoplastic left heart syndrome with at least moderate tricuspid regurgitation who underwent valve intervention between 2007 and 2021 at our institution; charts were retrospectively reviewed for data.

Results: Eleven patients (73% male) underwent valve replacement (median age, 3 years). Preoperative ventricular systolic function was normal in 10 patients (91%). Median follow-up postoperatively was 4 years with no early mortality, 1 (9%) late mortality, and 1 heart transplant (9%). Morbidity consisted of complete heart block in 1 patient (9%), with no important hemorrhagic or thrombotic events. Among survivors of replacement (n = 9), ventricular function was preserved in all (n = 8) who had normal function preoperatively and improved in the remaining patient. Sixteen patients underwent valve repair (median age, 4 months) with no early mortality, 8 (50%) midterm mortalities, and 2 heart transplants (12%).

Conclusions: Tricuspid valve replacement is a feasible option in hypoplastic left heart syndrome with significant tricuspid regurgitation, with favorable outcomes in the intermediate follow-up. When undertaken in the setting of normal function, ventricular function may be preserved in up to 80% of patients. Long-term follow-up is needed.

Keywords: AVVR, atrioventricular valve regurgitation; HLHS, hypoplastic left heart syndrome; RV, right ventricle; TR, tricuspid regurgitation; anticoagulation; hypoplastic left heart syndrome; single ventricle; tricuspid regurgitation; valve replacement.

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Figures

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Graphical abstract
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Timing and outcomes for tricuspid valve surgery in patients with HLHS.
Figure 1
Figure 1
Timing and outcomes for tricuspid valve surgery in patients with HLHS.
Figure 2
Figure 2
Kaplan–Meier curve depicting freedom from death and transplant in patients undergoing tricuspid valve repair (red, n = 16) and tricuspid valve replacement (blue, n = 11). Because the groups were dissimilar, no statistical comparison was made.
Figure 3
Figure 3
Mechanical replacement of the tricuspid valve in HLHS is feasible at or beyond second-stage palliation in HLHS; repair is feasible at any stage, but outcomes are worse in earlier stages when replacement is not possible.
See this image and copyright information in PMC

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