title: Tricuspid valve repair and pulmonary valve replacement in adults with repaired tetralogy of Fallot.
abstract: Pulmonary valve replacement (PVR) often is performed in adults with repaired tetralogy of Fallot (TOF). For patients who have tricuspid regurgitation (TR), tricuspid valve (TV) repair associated to PVR is still debated.
  
  
  
  We sought to evaluate perioperative factors related to TV repair when performed at the time of PVR in patients with repaired TOF.
  
  
  
  We retrospectively reviewed 104 patients with repaired TOF (or its equivalent) who underwent PVR (2002-2014).
  
  
  
  Mean age at initial complete correction and at PVR was 20.1 ± 17.2 months and 26.3 ± 9.5 years, respectively. Forty-one patients had significant preoperative TR: 24 were moderate (group M) and 17 were severe (group S). A total of 16 TV repair were performed (8 for each group). Moderate and severe tricuspid regurgitation observed in the first year following the initial complete repair were significantly associated with severe TR at PVR (P < .001). In group M patients, TR was improved regardless of TV repair, whereas, in group S, residual significant TR was reported in 7 patients who did not have TV repair. No cases were observed for patients who underwent concomitant TV repair (P = .002). Among these patients with residual significant TR, 2 needed a tricuspid valve replacement. The functional status (New York Heart Association classification) of group S patients was significantly improved by concomitant TV repair.
  
  
  
  In adults with repaired TOF, TV repair is a safe procedure when performed at the time of PVR. If, at mid-term follow-up, there is probably no benefit of TV repair when preoperative TR is moderate, TV repair may improve both tricuspid valve function and functional status of the patients in case of severe preoperative TR.
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Roubertie
authors.affiliation: Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France. Electronic address: peseguela@yahoo.fr.
authors.forename: Pierre-Emmanuel
authors.initials: PE
authors.lastname: Séguéla
authors.affiliation: Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Zakaria
authors.initials: Z
authors.lastname: Jalal
authors.affiliation: Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Iriart
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Roques
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Kreitmann
authors.affiliation: Department of Cardiovascular Surgery, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Yamani
authors.affiliation: Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Pillois
authors.affiliation: Department of Pediatric and Congenital Cardiology, Bordeaux University Hospital, Bordeaux, France.
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Thambo
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D011664:Pulmonary Valve / Q000601:surgery*; D012189:Retrospective Studies; D013771:Tetralogy of Fallot / Q000601:surgery*; D014261:Tricuspid Valve / Q000601:surgery*; D014262:Tricuspid Valve Insufficiency / Q000601:surgery*
keywords: congenital heart disease; pulmonary valve replacement; tetralogy of Fallot; tricuspid valve repair