Concomitant Tricuspid Valve Repair of Any Kind at Pulmonary Valve Replacement is Advantageous for Late Tricuspid Valve Function in Adults with Repaired Tetralogy of Fallot

136 

Abstract Submission 

Myunghyun Michael Lee (1), Leyre Alvarez Rodriguez (2), Ayako Ishikita (2), Rachel Wald (2), Osami Honjo (1), David Barron (1)

(1) Hospital for Sick Children, Toronto, Ontario, (2) Toronto General Hospital, Toronto, Ontario

Myunghyun Michael Lee    -  Contact Me
Hospital for Sick Children

Leyre Alvarez Rodriguez    -  Contact Me
Toronto General Hospital

Ayako Ishikita    -  Contact Me
Toronto General Hospital

Rachel Wald    -  Contact Me
Toronto General Hospital

*Osami Honjo    -  Contact Me
Hospital for Sick Children

*David Barron    -  Contact Me
Hospital for Sick Children

Myunghyun Michael Lee    -  Contact Me
N/A

Objective: To investigate late effect of concomitant tricuspid valve surgery (TVS) at time of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (rTOF).
Methods: 562 patients undergoing pulmonary valve replacement (PVR) were screened. Exclusion criteria were non-rTOF diagnosis, incomplete surgical note, echocardiographic, or cardiac magnetic resonance imaging (CMR). Outpatient echocardiography was obtained at mean follow-up 11.0±5.5 years. CMR was performed at mean follow-up 2.1±2.0 years and 6.8±6.0 years after surgery.
Results: A total of 196 rTOF patients were categorized into PVR (n=161) vs PVR-TVS (n=35). TVS techniques were reinforced annuloplasty (band or ring) (51.4%;n=18) and DeVega annuloplasty (48.6%;n=17). TV morphology was normal in 98.1% PVR (n=157) and 77.1% PVR-TVS (n=35) (HR 0.2±0.1[CI 0.1-0.6];p<0.01). Mean age at surgery was 43.2±11.7 years for PVR compared with 47.7±12.8 years for PVR-TVS (p=0.02). Preoperative moderate or greater tricuspid regurgitation (mTR) was present in 20.5% PVR (n=33), compared to expectedly higher incidence, 91.4% in PVR-TVS (n=32;p<0.01). Preoperative mean right ventricular end-diastolic volume index (RVEDVi) was higher in PVR-TVS than PVR (225±49 vs 186±35 mL/m2;p<0.01). There was no difference in preoperative RV ejection fraction (RVEF) between both groups. Concomitant arrhythmia surgery occurred in 9.3% PVR (n=15) and 34.3% PVR-TVS (n=12;p<0.01). There were no differences in RV outflow tract resection (19.3% PVR [n=31] vs 11.4% PVR-TVS [n=4]), residual atrial septal defect (21.1% PVR [n=34] vs 25.7% PVR-TVS [n=9]) or ventricular septal defect closure (5.6% PVR [n=9] vs 11.4% PVR-TVS [n=4]). Postoperatively, RVEDVi decreased in both groups (186±35 to 121±28 mL/m2 in PVR vs 225±49 to 143±38 mL/m2 in PVR-TVS;p<0.01). RVEF was unchanged. At mean follow-up 9.9±5.8 years, recurrent mTR was 9.9% PVR (n=16) vs 34.3% PVR-TVS (n=12;p<0.01). Despite much higher initial prevalence of mTR, benefit of PVR-TVS was sustained at 10 years with >65% mTR abolished whereas PVR showed progressive mTR over time. Freedom from recurrent mTR appeared similar irrespective of TVS technique (Figure).
Conclusions: Patients undergoing PVR-TVS were older with greater RV dimension, more thickened TV, and higher prevalence of mTR at presentation. Although both PVR and PVR-TVS reduced RV dimension and TR severity, concomitant TV repair of any kind produced sustained benefit against late recurrent mTR.

Adult Congenital