PMID- 26984988 OWN - NLM STAT- MEDLINE DCOM- 20170713 LR - 20170817 IS - 1873-734X (Electronic) IS - 1010-7940 (Linking) VI - 50 IP - 3 DP - 2016 Sep TI - Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles. PG - 456-63 LID - 10.1093/ejcts/ezw059 [doi] AB - OBJECTIVES: In patients with congenitally corrected transposition of the great arteries (ccTGA) or after atrial (Mustard or Senning) correction for transposition of the great arteries (acTGA), the right ventricle (RV) supports the systemic circulation. The tricuspid valve (TV) (systemic atrioventricular valve) is prone to regurgitation in these patients and this is associated with impending RV failure and decreased survival. This study evaluates mid-term functional improvements, echocardiographic findings and survival after TV surgery in this patient group. METHODS: From July 1999 to November 2014, 26 patients (mean age 37.1 +/- 12.3 years, 14 females) with ccTGA (n = 15) or acTGA (n = 11) had TV surgery. All patients had RV dysfunction and more-than-moderate TV regurgitation (TR); 14 underwent TV replacement (TVR) and 12 had valvuloplasty (TVP). Main outcomes were New York Heart Association (NYHA) functional class, TR and RV dysfunction at 1 year postoperatively and at latest follow-up. Complications and freedom from the composite end-point of death or recurrent TR were analysed. RESULTS: The median follow-up time was 5.9 years (range, 0-16.1 years). Mean NYHA functional class significantly improved to 1.7 [95% confidence interval (CI): 1.3-2.1] at 1 year (P= 0.004) and was 2.1 (95% CI: 1.7-2.6) at latest follow-up (P= 0.14). TV competence significantly improved to a mean TR grade of 1.1 (95% CI: 0.5-1.7) at latest follow-up (P< 0.001). The mean grade for RV function at latest follow-up was 2.7 (95% CI: 2.3-3.0). Most encountered postoperative complications were arrhythmias and temporary haemodynamic instability due to low cardiac output. Early mortality was 11.5% (n = 3); late mortality was 15.4% (n = 4). Estimated freedom from the composite end-point of death or recurrent TR was 76.9% (95% CI: 55.7-88.9%) at 1 year and 64.8% (95% CI: 43.2-79.9%) at 5 years. In TVP patients, TV function at 1 year and at latest follow-up was significantly worse than in TVR patients (P< 0.001 and P= 0.003, respectively). Also, TVP patients had a significantly lower composite end-point survival curve compared with TVR patients (P= 0.018). CONCLUSIONS: In this patient group, TV surgery showed stabilization of RV function and improvement of NYHA functional class for at least several years. In this series, TVR appears superior to TVP with respect to occurrence of recurrent TR. Early and late mortality after TV surgery is substantial, and we believe that patients with significant TR should be referred earlier for surgery for better outcome. CI - (c) The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. FAU - Koolbergen, David R AU - Koolbergen DR AD - Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands d.r.koolbergen@amc.nl. FAU - Ahmed, Yunus AU - Ahmed Y AD - Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands. FAU - Bouma, Berto J AU - Bouma BJ AD - Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands. FAU - Scherptong, Roderick W C AU - Scherptong RW AD - Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands. FAU - Bruggemans, Eline F AU - Bruggemans EF AD - Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands. FAU - Vliegen, Hubert W AU - Vliegen HW AD - Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands. FAU - Holman, Eduard R AU - Holman ER AD - Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands. FAU - Mulder, Barbara J M AU - Mulder BJ AD - Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands. FAU - Hazekamp, Mark G AU - Hazekamp MG AD - Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands. LA - eng PT - Journal Article DEP - 20160316 PL - Germany TA - Eur J Cardiothorac Surg JT - European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery JID - 8804069 SB - IM MH - Adult MH - Balloon Valvuloplasty/adverse effects/*methods MH - Echocardiography MH - Female MH - Follow-Up Studies MH - Heart Valve Prosthesis Implantation/adverse effects/*methods MH - Humans MH - Kaplan-Meier Estimate MH - Male MH - Middle Aged MH - Recurrence MH - Transposition of Great Vessels/*surgery MH - Treatment Outcome MH - Tricuspid Valve Insufficiency/diagnostic imaging/etiology/*surgery MH - Ventricular Dysfunction, Right/diagnostic imaging/etiology/*surgery OTO - NOTNLM OT - Replacement OT - Surgery OT - Systemic right ventricle OT - Transposition of the great arteries OT - Tricuspid valve OT - Valvuloplasty EDAT- 2016/03/18 06:00 MHDA- 2017/07/14 06:00 CRDT- 2016/03/18 06:00 PHST- 2015/09/17 00:00 [received] PHST- 2016/01/25 00:00 [accepted] PHST- 2016/03/18 06:00 [entrez] PHST- 2016/03/18 06:00 [pubmed] PHST- 2017/07/14 06:00 [medline] AID - ezw059 [pii] AID - 10.1093/ejcts/ezw059 [doi] PST - ppublish SO - Eur J Cardiothorac Surg. 2016 Sep;50(3):456-63. doi: 10.1093/ejcts/ezw059. Epub 2016 Mar 16.