title: Follow-up after tricuspid valve surgery in adult patients with systemic right ventricles.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands d.r.koolbergen@amc.nl.
authors.forename: David R
authors.initials: DR
authors.lastname: Koolbergen
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Yunus
authors.initials: Y
authors.lastname: Ahmed
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Berto J
authors.initials: BJ
authors.lastname: Bouma
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Roderick W C
authors.initials: RW
authors.lastname: Scherptong
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Eline F
authors.initials: EF
authors.lastname: Bruggemans
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Hubert W
authors.initials: HW
authors.lastname: Vliegen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Eduard R
authors.initials: ER
authors.lastname: Holman
authors.affiliation: Department of Cardiology, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Barbara J M
authors.initials: BJ
authors.lastname: Mulder
authors.affiliation: Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands Department of Cardiothoracic Surgery, Academic Medical Center, Amsterdam, Netherlands.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Hazekamp
mesh_terms: D000328:Adult; D063126:Balloon Valvuloplasty / Q000009:adverse effects / Q000379:methods*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D014188:Transposition of Great Vessels / Q000601:surgery*; D016896:Treatment Outcome; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*
keywords: Replacement; Surgery; Systemic right ventricle; Transposition of the great arteries; Tricuspid valve; Valvuloplasty