The long-term impact of the tricuspid valve intervention after Fontan completion in patients with single right ventricle

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Abstract Submission 

Yuriy Kulyabin (1), Ilya Soynov (1), Nataliya Nichay (1), Timothy Lancaster (2), Vikram Sood (2), Jennifer Romano (2), Richard Ohye (2), Jiyong Moon (2)

(1) E.Meshalkin National Medical Research Center, Novosibirsk, Russia, (2) C. S. Mott Children's Hospital, Ann Arbor, MI

Yuriy Kulyabin    -  Contact Me
E.Meshalkin National Medical Research Center

Ilya Soynov    -  Contact Me
E.Meshalkin National Medical Research Center

Nataliya Nichay    -  Contact Me
E.Meshalkin National Medical Research Center

Timothy Lancaster    -  Contact Me
C. S. Mott Children's Hospital

Vikram Sood    -  Contact Me
C. S. Mott Children's Hospital

*Jennifer Romano    -  Contact Me
C. S. Mott Children's Hospital

*Richard Ohye    -  Contact Me
C. S. Mott Children's Hospital

Jiyong Moon    -  Contact Me
C. S. Mott Children's Hospital

Yuriy Kulyabin    -  Contact Me
N/A

Objective: Reveal the long-term impact of tricuspid valve intervention on survival after Fontan completion.
Methods: A single-center retrospective cohort study was conducted with patients who underwent Fontan completion from 1985 through 2017. Data was obtained by chart review, and transplant and survival outcomes were linked to the scientific registry of transplant recipients and the national death index. There were a total of 675 morphological single right ventricle patients. Among them, 128 patients underwent TV intervention at any stage. The primary outcome was transplant- and Fontan takedown-free survival, which was compared between the non-TV intervention (NTV) and TV intervention (TVi) groups. Sub-analysis was performed for patients requiring repeat TV interventions.
Results: Median follow-up was 8.8 (±7.6) years. Of the overall cohort of 675 patients, 487 had HLHS (72%) and 66 had heterotaxy (10%). Among the 128 TV intervention patients, 28 patients underwent repeat TV intervention (22%). Fifty-five (43%) patients underwent TV intervention before Fontan (40 - at stage 2, 15 - during interstage period), 60 (47%) patients at the time of Fontan completion, and 13 (10%) patients after Fontan. The NTV and TVi had no significant differences in background characteristics except for TV insufficiency before Fontan completion (NTV 8.4% vs. TVi 53.9%, P<0.001). There were no significant differences in early mortality after Fontan (NTV 6% vs. TVi 8.6%, P=0.32) nor prolonged chest tube drainage after Fontan (P=0.81). Overall transplant- and Fontan takedown-free survival was 62.5% at 20 years (Fig.1). There was no significant survival difference between NTV and TVi (NTV 76% and TVi 72% at 15 years, P=0.06). However, repeat TV interventions showed an inferior survival outcome compared to the NTV group (NTV 76%, vs. TVi 73%, vs. repeat TVi 56% at 15 years, P=0.03, HR 1.41). Follow-up echo data showed 34 (35%) patients in TVi and 14 (50%) patients in repeat TVi had more than moderate TV regurgitation.
Conclusions: Although repeat TV intervention was associated with inferior survival outcomes, successful TV intervention can provide comparable long-term survival outcomes to non-TV intervention patients undergoing staged single ventricle palliation.

Single Ventricle Management