Results for tricuspid valve surgery in adults with congenital heart disease other than Ebstein's anomaly†

OBJECTIVES: Tricuspid valve (TV) surgery in the adult with congenital heart disease (ACHD) is a frequently performed procedure. The aim of this study was to analyse postoperative and medium-term outcomes. METHODS: We conducted a single-centre retrospective study of patients with ACHD who underwent TV surgery (January 2000-December 2016); patients with Ebstein's anomalies were excluded. Operative and clinical records were reviewed. Outcomes considered were survival, grade of insufficiency/stenosis and TV reoperation at follow-up. RESULTS: A total of 128 patients with ACHD had TV surgery for functional regurgitation (n=95), dysplasia (n=23) and systemic TV (n=10). Median age was 40.8 years [interquartile range (IQR) 25.3]; 55.5% were men. Preoperative regurgitation was classified as mild (n=8), moderate (n=47) and severe (n=70). The TV was repaired in 109 as follows: ring annuloplasty (n=43), de Vega annuloplasty (n=29), Wooler annuloplasty (n=13), commissural plasty (n=9), Kay annuloplasty (n=7) and others (n=8). The TV was replaced in 19 patients with biological (n=10) and mechanical (n=9) prostheses. The median hospital stay was 12 days (IQR 10). The overall mortality rate was 8.6% (n=11): 2 hospital deaths (1.6%) and 9 late deaths. Survival was 93% [95% confidence interval (CI) 85-97%] at 5 years and 83% (95% CI 70-91%) at 10 years. The median follow-up period was 4.95 years (IQR 7.7) with 1 TV reoperation. Echocardiographic assessment showed >= moderate regurgitation in 34 (34.3%) patients. Suture plasty had a significantly higher incidence of TV regurgitation >= moderate compared to ring annuloplasty (48.9% vs 26.3%; P=0.033). CONCLUSIONS: TV surgery in the ACHD is frequently associated with other main procedures. Stabilizing the TV annulus with a prosthetic ring guarantees lower recurrence of moderate to severe regurgitation compared to suture plasty repair.