Tricuspid Regurgitation and Impact of Surgical Valve Intervention in the Single Ventricle Reconstruction Trial.
J F Cnota, S M Chowdhury, A Floh et al.
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In 30 seconds
This analysis of the Pediatric Heart Network’s Single Ventricle Reconstruction trial examined serial tricuspid regurgitation (TR) and transplant-free survival in children with single right ventricle anomalies followed to age 6 years. Echocardiograms were assessed at six stages of palliation, and TR was classified as mild or less versus greater than mild. Greater-than-mild TR increased from 12 to 24% between baseline and after the Norwood operation (p < 0.001), then remained stable among survivors. It was associated with lower transplant-free survival at several time points; early tricuspid valve intervention was not associated with improved survival.
Key findings
- Greater-than-mild TR rose from 12 to 24% from baseline to post-Norwood (p < 0.001), with the proportion stable thereafter among survivors.
- Transplant-free survival at 6 years was lower with greater-than-mild TR at every assessed time except pre-Fontan.
- Greater-than-mild TR was associated with larger baseline tricuspid valve annular area and greater right ventricular volume, but not reduced function.
- Tricuspid valve intervention at Norwood and/or Stage II was associated with a higher rate of death or transplant than no intervention or later intervention.
Why it matters
The findings identify greater-than-mild TR as a marker associated with poorer transplant-free survival during staged palliation for single right ventricle anomalies. They also show that early valve intervention was not associated with better survival in this cohort, underscoring the need to interpret TR severity and intervention outcomes in the context of disease severity and timing.
What to keep in mind
The reported intervention comparisons are observational within the trial cohort, so they do not establish whether valve intervention changes survival.