title: Tricuspid repair at pulmonary valve replacement does not alter outcomes in tetralogy of Fallot.
abstract: BACKGROUND
  Chronic pulmonary regurgitation after tetralogy of Fallot repair often leads to progressive right ventricle dilation, dysfunction, and frequently, pulmonary valve replacement. For those with significant tricuspid regurgitation at the time of pulmonary valve replacement, it is unknown whether concomitant tricuspid valve repair improves postoperative outcomes.
  
  
  METHODS
  This is a retrospective review of patients after tetralogy of Fallot repair who underwent pulmonary valve replacement between 1999 and 2012. Preoperative and postoperative echocardiograms were assessed for tricuspid regurgitation (vena contracta) and right ventricular size and function (Tomtec software).
  
  
  RESULTS
  Sixty-two patients underwent pulmonary valve replacement. Thirty-six (58%) had greater than or equal to moderate tricuspid regurgitation on preoperative echocardiogram. Significant predictors were not identified. Of the 36, 18 (50%) underwent concomitant tricuspid valve repair at the time of pulmonary valve replacement. After surgery, there was a significant reduction in the degree of tricuspid regurgitation (p < 0.001) and measures of right ventricular size (p < 0.05) in both cohorts. Between surgical groups, there was no statistical difference in the grade of tricuspid regurgitation (p = 0.47) or measures of right ventricular size (p > 0.4) at 6-month follow-up.
  
  
  CONCLUSIONS
  Tricuspid regurgitation is a common finding in repaired tetralogy of Fallot, although risk factors for its development remain unclear. After pulmonary valve replacement with or without tricuspid valve repair there is significant improvement in the degree of tricuspid regurgitation and right ventricular size. Finally, 6 months after pulmonary valve replacement there were no statistical differences between those patients undergoing concomitant tricuspid valve repair and those undergoing pulmonary valve replacements alone.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Cramer
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Salil
authors.initials: S
authors.lastname: Ginde
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Garick D
authors.initials: GD
authors.lastname: Hill
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Cohen
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Bartz
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
authors.forename: James S
authors.initials: JS
authors.lastname: Tweddell
authors.affiliation: Department of Pediatrics, Division of Cardiology, Medical College of Wisconsin, Milwaukee, Wisconsin; Department of Internal Medicine, Division of Adult Cardiovascular Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: mearing@chw.org.
authors.forename: Michael G
authors.initials: MG
authors.lastname: Earing
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D013771:Tetralogy of Fallot / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000601:surgery*; D055815:Young Adult