Abstract 19399: Failure to Adequately Reduce Tricuspid Valve Size in Hypoplastic Left Heart Syndrome: Tricuspid Valve Repair is an Important Mechanism of Significant Post-Operative Regurgitation
Background: Tricuspid valve regurgitation (TR) is associated with morbidity and mortality in hypoplastic left heart syndrome (HLHS). Successful tricuspid valve repair (TVR) may improve outcomes, however 30-50% of patients develop significant post-operative TR, often requiring further surgery. We sought to determine pre-operative factors associated with development of TR after TVR in HLHS.
Methods: Twenty-six HLHS patients requiring TVR for TR between 2005 and 2015 were assessed. 2D echocardiography (2DE) was used pre-op and late post-op (> 6 months) to assess TR grade, vena contracta (VC) size and annulus size. Patients were divided into those with ≤ mild TR (group A) and those with ≥ moderate TR (group B) at late post-op. Pre-op 3D echocardiography (3DE) was used to assess mechanism and location of TR. Surgical notes were reviewed for repair details.
Results: Fourteen patients (54%) had ≤ mild TR (group A) and 12 (46%) had ≥ moderate TR (group B) at late post-op. TVR occurred most commonly with other surgical procedures (2 at Norwood, 8 at Glenn, and 7 at Fontan). On preop 3DE, 13 (52%) had central TR, 7 (28%) had central TR with extension into a commissure, 2 (8%) had anterior-septal TR, and 3 (12%) had mixed commissural TR. The primary mechanism was tethering in 14 (56%) and prolapse in 12 (44%). For surgical repair, 17 (65%) had posterior annuloplasty, 5 (19%) cleft closure, and 4 (16%) other. Types of surgical repair were similar between the 2 groups.
Group A had smaller pre-op 2DE TV annulus Z-score (3.4 vs 5.0, P=0.013) but no difference in pre-op 2DE VC diameter, when compared to group B. Group A pre and post op-comparison showed reduced annulus Z-score (3.4 vs 0.8, P=0.01) and VC diameter (p=0.01), while Group B pre and post op annulus size and VC size showed no reduction. There was no difference between group A and B with respect to TR location or primary mechanism involved. Late post-op VC demonstrated moderate correlation with pre-op TV annulus size (P=0.005; R=0.54) but not with pre-op VC.
Conclusion: TR after valve repair is common. Larger pre op annulus size is related to post-operative TR. Despite surgical repair aimed at reducing TV annulus size, failure to adequately reduce TV size appears to be a mechanism of persistent significant post-operative regurgitation in HLHS.
Author Disclosures: K. Mah: None. B. Martin: None. S. Alvarez: None. N. Alami Laroussi: None. I.M. Rebeyka: None. J. Smallhorn: None. N. Khoo: None. T. Colen: None.
- © 2016 by American Heart Association, Inc.