title: Effects of tricuspid valve surgery on tricuspid regurgitation in patients with hypoplastic left heart syndrome: a non-randomized series comparing surgical and non-surgical cases.
abstract: OBJECTIVE
  Tricuspid regurgitation (TR) remains a significant risk factor affecting the survival of patients with hypoplastic left heart syndrome (HLHS). We performed this study to investigate differences in the clinical course based on the timing of the development of TR and the effects of tricuspid valve surgery (TVS).
  
  
  METHODS
  One hundred and five patients of classic HLHS underwent staged operations from May 1991 to July 2010. Forty-four patients (41.9%) exhibited moderate or greater TR during the follow-up. We defined the early TR group (30 patients, around the first palliative surgery) and the late TR group (14 patients, the later period) based on the timing of the appearance of moderate or greater TR. We performed TVS when moderate or greater TR was detected in 28 patients. The follow-up period was 5.5 ± 5.1 (plus/minus values are means ± SD) years (range: 0.01-14.6 years) after the first palliative surgery and 4.9 ± 4.4 years (range: 0.01-13.3 years) after TVS.
  
  
  RESULTS
  The early TR group exhibited poorer survival than the late TR group (42.9 vs 92.9% at 5 years, P = 0.003). However, in the early TR group, the TVS significantly improved survival compared with that observed in the non-TVS cases (52.1 vs 23.3% at 5 years, P = 0.046). The right ventricular ejection fraction (RVEF) significantly decreased (62.7 ± 11.4 → 57.2 ± 12.6% (plus/minus values are means ± SD), P = 0.040) and the right ventricular end-diastolic diameter (RVDd) became significantly enlarged (27.7 ± 7.6 → 36.7 ± 3.4 mm, P < 0.001) in association with deterioration of the TR degree. TVS significantly improved the degree of TR (2.5 ± 0.5 → 1.5 ± 0.9°, P < 0.001) and RVDd (37.7 ± 7.4 → 30.4 ± 5.0 mm, P = 0.007); however, the RVEF was not improved 1 month after surgery (54.4 ± 12.1 → 54.3 ± 12.4%, P = 0.931) or at the latest follow-up (53.7 ± 14.9%, P = 0.836).
  
  
  CONCLUSIONS
  The survival of HLHS patients who develop moderate or greater TR around the time of the first palliative surgery is worse than that of HLHS patients who develop moderate or greater TR at a later time. In this study, TVS for early TR improved survival and decreased right ventricular dimensions during the 4.9-year follow-up period.
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Chuo-ku, Fukuoka, Japan junyafine@hotmail.com.
authors.forename: Junya
authors.initials: J
authors.lastname: Sugiura
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Chuo-ku, Fukuoka, Japan.
authors.forename: Toshihide
authors.initials: T
authors.lastname: Nakano
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Chuo-ku, Fukuoka, Japan.
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Oda
authors.affiliation: Department of Cardiothoracic Surgery, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Usui
authors.affiliation: Department of Cardiovascular Surgery, Tenri Yorozu Hospital, Tenri, Japan.
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ueda
authors.affiliation: Department of Cardiovascular Surgery, Fukuoka Children's Hospital, Chuo-ku, Fukuoka, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kado
mesh_terms: D058385:Cardiac Valve Annuloplasty; D002675:Child, Preschool; D003971:Diastole; D004452:Echocardiography; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome / Q000150:complications / Q000401:mortality*; D007223:Infant; D007231:Infant, Newborn; D058327:Norwood Procedures; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013318:Stroke Volume; D014261:Tricuspid Valve / Q000601:surgery; D014262:Tricuspid Valve Insufficiency / Q000209:etiology / Q000401:mortality* / Q000601:surgery*
keywords: Hypoplastic left heart syndrome; Tricuspid regurgitation; Tricuspid valve